Provider Demographics
NPI:1902960990
Name:LYCHE, KARE HENRIKSON (MD)
Entity type:Individual
Prefix:
First Name:KARE
Middle Name:HENRIKSON
Last Name:LYCHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KARE
Other - Middle Name:ANN
Other - Last Name:HENRIKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:407 S CLAIRBORNE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1744
Mailing Address - Country:US
Mailing Address - Phone:913-468-2266
Mailing Address - Fax:
Practice Address - Street 1:407 S CLAIRBORNE RD STE 104
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1744
Practice Address - Country:US
Practice Address - Phone:913-468-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA061158207Q00000X
MO2006020977207Q00000X
KS32015207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC703786Medicaid
CAFHC703786Medicaid
G81593Medicare UPIN