Provider Demographics
NPI:1992757629
Name:MCCROSKEY, LON C (LON MCCROSKEY, MD)
Entity type:Individual
Prefix:DR
First Name:LON
Middle Name:C
Last Name:MCCROSKEY
Suffix:
Gender:M
Credentials:LON MCCROSKEY, MD
Other - Prefix:MR
Other - First Name:LON
Other - Middle Name:
Other - Last Name:MCCROSKEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LON MCCROSKEY
Mailing Address - Street 1:6613 WENONGA
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66208
Mailing Address - Country:US
Mailing Address - Phone:913-384-3308
Mailing Address - Fax:
Practice Address - Street 1:5701 W 119TH ST
Practice Address - Street 2:STE. 331
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3721
Practice Address - Country:US
Practice Address - Phone:913-696-1146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0419116174400000X
MOR4B94174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100204810BMedicaid
MO202268629Medicaid
KS100204810BMedicaid
KSN204750Medicare PIN
MO202268629Medicaid