Provider Demographics
NPI:1508154659
Name:MARTIS, PAUL (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:MARTIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2090 W DARTMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-6869
Mailing Address - Country:US
Mailing Address - Phone:913-356-8300
Mailing Address - Fax:913-356-8711
Practice Address - Street 1:23450 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061
Practice Address - Country:US
Practice Address - Phone:913-764-7788
Practice Address - Fax:913-764-6088
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2018-06-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS04-37376207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201102650BMedicaid