Provider Demographics
NPI:1063909711
Name:ELMORE, CAITLIN ANNE (MD)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ANNE
Last Name:ELMORE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:325 MAINE ST
Mailing Address - Street 2:MSO LIBRARY
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1360
Mailing Address - Country:US
Mailing Address - Phone:785-505-2988
Mailing Address - Fax:785-505-5228
Practice Address - Street 1:6265 ROCK CHALK DR STE 1100
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-5232
Practice Address - Country:US
Practice Address - Phone:785-842-5070
Practice Address - Fax:785-505-5264
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-46667208D00000X, 208D00000X
MO2018017386208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004836230001Medicaid