Basic Information
| Provider Information | |||||||||
| NPI: | 1760606149 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SORBIN | ||||||||
| FirstName: | KORTNEE | ||||||||
| MiddleName: | LANNING | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LANNING | ||||||||
| OtherFirstName: | KORTNEE | ||||||||
| OtherMiddleName: | BRIE | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10301 HICKMAN MILLS DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641371674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167635446 | ||||||||
| FaxNumber: | 8167638426 | ||||||||
| Practice Location | |||||||||
| Address1: | 5721 W 119TH ST | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662093722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167635446 | ||||||||
| FaxNumber: | 8167638426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 03/05/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 2010037966 | MO | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 0432501 | KS | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 200430340B | 05 | KS | MEDICAID | 207552209 | 05 | MO | MEDICAID |