Provider Demographics
NPI:1972519858
Name:RHODES, MARTIN (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:RHODES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000-M LEAVENWORTH RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66104
Mailing Address - Country:US
Mailing Address - Phone:913-299-0089
Mailing Address - Fax:913-299-0873
Practice Address - Street 1:632 KANSAS AVENUE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66105
Practice Address - Country:US
Practice Address - Phone:913-371-1017
Practice Address - Fax:913-371-8326
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0415198207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS420982OtherBCBS OF KANSAS
MO03339081OtherBCBS OF KC
KS1000939980BMedicaid
MO03339081OtherBCBS OF KC
KS420982OtherBCBS OF KANSAS