Provider Demographics
NPI:1578881942
Name:MARKS, SARAH TULLY (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:TULLY
Last Name:MARKS
Suffix:
Gender:F
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:PO BOX 411851
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1851
Mailing Address - Country:US
Mailing Address - Phone:913-588-1944
Mailing Address - Fax:913-588-2496
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:MS 4017
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-8500
Practice Address - Country:US
Practice Address - Phone:913-588-1944
Practice Address - Fax:913-588-2496
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP432207Q00000X
390200000X
KS04-36643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program