Provider Demographics
NPI:1477651073
Name:BUCKMAN, MARTIN S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:S
Last Name:BUCKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10601 QUIVIRA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2310
Mailing Address - Country:US
Mailing Address - Phone:913-541-3340
Mailing Address - Fax:913-492-7857
Practice Address - Street 1:10601 QUIVIRA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2310
Practice Address - Country:US
Practice Address - Phone:913-541-3340
Practice Address - Fax:913-492-7857
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KSKS418354207R00000X
MOMO35666207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200575030AMedicaid
MO1477651073Medicaid
KS1477651073OtherBCBS OF KS
KSC50370Medicare UPIN
MO0004239AMedicare ID - Type Unspecified
KS1477651073OtherBCBS OF KS
KSP00654735Medicare PIN