Basic Information
| Provider Information | |||||||||
| NPI: | 1497017149 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PENA | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | PIEZAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10787 NALL AVE STE 310 | ||||||||
| Address2: | MEDICAL PLAZA INTERNAL MEDICINE | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9139456900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10787 NALL AVE STE 310 | ||||||||
| Address2: | MEDICAL PLAZA INTERNAL MEDICINE | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9139456900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2012 | ||||||||
| LastUpdateDate: | 07/20/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0438204 | KS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 9407909 | KS | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.