Provider Demographics
NPI:1194526442
Name:LOPES FERMINO, MARISE (MD)
Entity type:Individual
Prefix:
First Name:MARISE
Middle Name:
Last Name:LOPES FERMINO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 W 106TH ST STE 325
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2381
Mailing Address - Country:US
Mailing Address - Phone:913-541-6022
Mailing Address - Fax:
Practice Address - Street 1:12200 W 106TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2305
Practice Address - Country:US
Practice Address - Phone:913-541-6022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-22
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program