Provider Demographics
NPI:1154300101
Name:PHILLIPS, JENNIFER GALESKI (DPM)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GALESKI
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:R
Other - Last Name:GALESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:5101 COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1614
Mailing Address - Country:US
Mailing Address - Phone:816-478-4200
Mailing Address - Fax:816-875-2598
Practice Address - Street 1:4801 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1628
Practice Address - Country:US
Practice Address - Phone:913-721-3387
Practice Address - Fax:816-875-2598
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023001845213E00000X
KS0345213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS33395016OtherBLUE CROSS/BLUE SHIELD
KSP00425788OtherRAILROAD MEDICARE
KS33395016OtherBLUE CROSS/BLUE SHIELD
KSQ99D129Medicare PIN