Provider Demographics
NPI:1144370750
Name:ANYANIKE, TISHA DARICE (MD)
Entity type:Individual
Prefix:
First Name:TISHA
Middle Name:DARICE
Last Name:ANYANIKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TISHA
Other - Middle Name:DARICE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1010 W US HIGHWAY 24 STE 100
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64050-2337
Mailing Address - Country:US
Mailing Address - Phone:816-690-5700
Mailing Address - Fax:816-708-0772
Practice Address - Street 1:1010 W US HIGHWAY 24 STE 100
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64050-2337
Practice Address - Country:US
Practice Address - Phone:816-690-5700
Practice Address - Fax:816-708-0772
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-31678207Q00000X, 207QG0300X, 207R00000X, 207RG0300X
MO2007013996207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS04-31678OtherMEDICAL LICENSE
KSP00379642OtherRR MEDICARE
KS200443070AMedicaid
MO2007013996OtherMEDICAL LICENSE
KS111023OtherMEDICARE GROUP ID
MOR28F156Medicare PIN
KS106244Medicare PIN