Provider Demographics
NPI:1609951367
Name:SHANK, EVE COLLINS (MD)
Entity type:Individual
Prefix:DR
First Name:EVE
Middle Name:COLLINS
Last Name:SHANK
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 1:700 W CENTRAL AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-2184
Mailing Address - Country:US
Mailing Address - Phone:316-321-8762
Mailing Address - Fax:316-321-8775
Practice Address - Street 1:700 W CENTRAL AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2184
Practice Address - Country:US
Practice Address - Phone:316-321-8762
Practice Address - Fax:316-321-8775
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28369207Y00000X
CAG72121207Y00000X
KSKS04-24830207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0730930OtherBCBSAZ
AZ735350Medicaid
KS100148290BMedicaid
KA2975001Medicare PIN
AZAZ0730930OtherBCBSAZ
KS100148290BMedicaid
AZ735350Medicaid