Provider Demographics
NPI:1710989082
Name:LASAK, JOHN MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARTIN
Last Name:LASAK
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 1:9350 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-4999
Mailing Address - Country:US
Mailing Address - Phone:316-686-6608
Mailing Address - Fax:316-686-3624
Practice Address - Street 1:9350 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2555
Practice Address - Country:US
Practice Address - Phone:316-686-6608
Practice Address - Fax:316-686-3624
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-29030207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS412510OtherFIRSTGAURD
KS9633OtherPHS-PPK
KS040016259OtherRAILROAD MEDICARE
KS100396360AMedicaid
KS100888OtherBLUE CROSS
KS48118525067206A003OtherCHAMPUS