Provider Demographics
NPI:1255301172
Name:KANNE, MARTIN ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:ANTHONY
Last Name:KANNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9411 N OAK TRFY
Mailing Address - Street 2:SUITE LL1
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2262
Mailing Address - Country:US
Mailing Address - Phone:816-436-7073
Mailing Address - Fax:716-436-2743
Practice Address - Street 1:9411 N OAK TRFY
Practice Address - Street 2:SUITE 100
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2262
Practice Address - Country:US
Practice Address - Phone:816-436-1800
Practice Address - Fax:816-436-4241
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOMDR4E89207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11217018OtherBCBS OF KC INDIVIDUAL #
0865242AMedicare PIN
C52219Medicare UPIN