Provider Demographics
NPI:1194781187
Name:DANNENBERG, MARSHA (MD)
Entity type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:
Last Name:DANNENBERG
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 1:2401 GILLHAM RD
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-701-5212
Mailing Address - Fax:816-302-9939
Practice Address - Street 1:6750 W 135TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-4802
Practice Address - Country:US
Practice Address - Phone:913-717-4700
Practice Address - Fax:913-717-4798
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0429492208000000X
MO2002002717208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I48026Medicare UPIN