Basic Information
| Provider Information | |||||||||
| NPI: | 1508154659 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTIS | ||||||||
| FirstName: | PAUL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2090 W DARTMOUTH ST | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660616869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133568300 | ||||||||
| FaxNumber: | 9133568711 | ||||||||
| Practice Location | |||||||||
| Address1: | 23450 COLLEGE BLVD | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137647788 | ||||||||
| FaxNumber: | 9137646088 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2011 | ||||||||
| LastUpdateDate: | 06/15/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 04-37376 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 201102650B | 05 | KS | MEDICAID |