Provider Demographics
NPI:1114940012
Name:MONZON, CARLOS MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:MANUEL
Last Name:MONZON
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 1:20930 W 151ST ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7228
Mailing Address - Country:US
Mailing Address - Phone:913-782-2525
Mailing Address - Fax:913-782-9307
Practice Address - Street 1:20930 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7228
Practice Address - Country:US
Practice Address - Phone:913-782-2525
Practice Address - Fax:913-782-9307
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0421796208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100131280BMedicaid
KS03302170Medicare ID - Type Unspecified
B18572Medicare UPIN