Provider Demographics
NPI:1598731002
Name:HAITH, BRIAN K (DPM PA)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:K
Last Name:HAITH
Suffix:
Gender:M
Credentials:DPM PA
Other - Prefix:DR
Other - First Name:BRIAN
Other - Middle Name:K
Other - Last Name:HAITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM PA
Mailing Address - Street 1:PO BOX 7310
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-0310
Mailing Address - Country:US
Mailing Address - Phone:913-648-7440
Mailing Address - Fax:913-648-7440
Practice Address - Street 1:4319 W 111TH TER
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1701
Practice Address - Country:US
Practice Address - Phone:913-648-7440
Practice Address - Fax:913-648-7440
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00272213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
22357013OtherBLUE CROSS BLUE SHIELD
MO308946508Medicaid
480032592OtherRRPTAN