Provider Demographics
NPI:1760779722
Name:CHAMPION, MARY T (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:T
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:7400 STATE LINE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3447
Mailing Address - Country:US
Mailing Address - Phone:913-588-6600
Mailing Address - Fax:913-588-6655
Practice Address - Street 1:7400 STATE LINE RD STE 100
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3447
Practice Address - Country:US
Practice Address - Phone:913-588-6600
Practice Address - Fax:913-588-6655
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2019-02-22
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Provider Licenses
StateLicense IDTaxonomies
KS1207W00000X
AZ50228207W00000X, 207WX0107X
KS0439896207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology