Provider Demographics
NPI:1326170549
Name:GREEN, MARK DARREN (NMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DARREN
Last Name:GREEN
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9359 W 75TH ST
Mailing Address - Street 2:BUILDING 6
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66204-4000
Mailing Address - Country:US
Mailing Address - Phone:913-825-6111
Mailing Address - Fax:913-825-6115
Practice Address - Street 1:9359 W 75TH ST
Practice Address - Street 2:BUILDING 6
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-4000
Practice Address - Country:US
Practice Address - Phone:913-825-6111
Practice Address - Fax:913-825-6115
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS21-00017175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath