| Liveactive Primary Care, Llc | |
|
6650 W 110th St Ste 220 Overland Park KS 66211-1501 | |
| (913) 549-3884 | |
| Not Available |
| Full Name | Liveactive Primary Care, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 6650 W 110th St Ste 220, Overland Park, Kansas |
| Authorized Official Name and Position | Haseeb A Ahmed (SOLE OWNER) |
| Authorized Official Contact | 9135493884 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Liveactive Primary Care, Llc 7111 W 151st St Ste 303 Overland Park KS 66223-2231 Ph: (913) 549-3884 | Liveactive Primary Care, Llc 6650 W 110th St Ste 220 Overland Park KS 66211-1501 Ph: (913) 549-3884 |
| NPI Number | 1245686625 |
|---|---|
| Provider Enumeration Date | 05/04/2016 |
| Last Update Date | 11/17/2021 |
| Medicare PECOS PAC ID | 9537414321 |
|---|---|
| Medicare Enrollment ID | O20190403000721 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245686625 | NPI | - | NPPES |
| Provider Name | Haseeb Ahmed |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972701571 PECOS PAC ID: 4587788013 Enrollment ID: I20100916000966 |
| Provider Name | Christopher Avila |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1043507148 PECOS PAC ID: 0547486045 Enrollment ID: I20140718000161 |
| Provider Name | Lisa M Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174097810 PECOS PAC ID: 6800122961 Enrollment ID: I20190726000867 |
| Provider Name | Ramiro C Montemayor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467001982 PECOS PAC ID: 4587078407 Enrollment ID: I20210210000276 |
| Provider Name | Madeleine J Dusselier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689338980 PECOS PAC ID: 7618361122 Enrollment ID: I20220228000601 |
| Provider Name | Marian L Phelps |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114684313 PECOS PAC ID: 2668867078 Enrollment ID: I20220322002312 |
| Provider Name | Junaid Ahmed |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1376830109 PECOS PAC ID: 1759530934 Enrollment ID: I20231115003324 |
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