Provider Demographics
NPI:1215461405
Name:MARTIN, MAX
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12330 METCALF AVE STE 420
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1307
Mailing Address - Country:US
Mailing Address - Phone:913-317-7840
Mailing Address - Fax:913-317-7395
Practice Address - Street 1:12330 METCALF AVE STE 420
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1307
Practice Address - Country:US
Practice Address - Phone:913-317-7840
Practice Address - Fax:913-317-7395
Is Sole Proprietor?:No
Enumeration Date:2017-04-14
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023012290207RP1001X
KS04-47802207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease