Provider Demographics
NPI:1558364117
Name:HORNUNG, BRIAN G (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:G
Last Name:HORNUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8550 MARSHALL DR STE 220
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1505
Mailing Address - Country:US
Mailing Address - Phone:913-451-4443
Mailing Address - Fax:913-495-3732
Practice Address - Street 1:8550 MARSHALL DR STE 200
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-9836
Practice Address - Country:US
Practice Address - Phone:913-495-2000
Practice Address - Fax:913-495-3715
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-26189207Q00000X
KS26189207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01100391OtherRR MEDICARE
KSP01085467OtherRR MEDICARE
KSH439181Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #
MOK67000039Medicare PIN
KSK67A00012Medicare PIN
KSP01085467OtherRR MEDICARE