Provider Demographics
NPI:1205036225
Name:TRAN, MARYANNE THU (MD)
Entity Type:Individual
Prefix:
First Name:MARYANNE
Middle Name:THU
Last Name:TRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 WALNUT ST
Mailing Address - Street 2:UNIT 1505
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64106-2134
Mailing Address - Country:US
Mailing Address - Phone:816-679-3879
Mailing Address - Fax:
Practice Address - Street 1:800 PEAKWOOD DR STE 5E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090
Practice Address - Country:US
Practice Address - Phone:281-440-5158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120161842085R0202X
KS04-358152085R0202X
TXN11892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200961800BMedicaid