Provider Demographics
NPI:1528060878
Name:CHEDIAK, ELIAS IV (MD)
Entity type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:
Last Name:CHEDIAK
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MISSOURI ST
Mailing Address - Street 2:STE 1
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2361
Mailing Address - Country:US
Mailing Address - Phone:785-841-7430
Mailing Address - Fax:785-841-6411
Practice Address - Street 1:601 MISSOURI ST
Practice Address - Street 2:STE 1
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2361
Practice Address - Country:US
Practice Address - Phone:785-841-7430
Practice Address - Fax:785-841-6411
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2014-01-14
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
KS147622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100089000AMedicaid
KS100089000AMedicaid
KS004283Medicare PIN