Provider Demographics
NPI:1427036797
Name:MOLOS, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:MOLOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7230 RENNER RD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-9901
Mailing Address - Country:US
Mailing Address - Phone:913-962-2122
Mailing Address - Fax:913-962-2422
Practice Address - Street 1:7230 RENNER RD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-9901
Practice Address - Country:US
Practice Address - Phone:913-962-2122
Practice Address - Fax:913-962-2422
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0419691207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100115530BMedicaid
MO201986049Medicaid
MOK33E866AMedicare PIN