Provider Demographics
NPI:1558360578
Name:DILEEPAN, KANAKAM (MD)
Entity type:Individual
Prefix:DR
First Name:KANAKAM
Middle Name:
Last Name:DILEEPAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 W 74TH ST
Mailing Address - Street 2:STE 3
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2204
Mailing Address - Country:US
Mailing Address - Phone:913-384-5775
Mailing Address - Fax:913-384-3990
Practice Address - Street 1:8901 W 74TH ST
Practice Address - Street 2:STE 3
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2204
Practice Address - Country:US
Practice Address - Phone:913-384-5775
Practice Address - Fax:913-384-3990
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS202162084P0800X, 2084P0804X
MOR6D122084P0800X, 2084P0804X
CAA428712084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
10735012OtherBLUE CROSS BLUE SHIELD
C52084Medicare UPIN
0006545Medicare ID - Type Unspecified