Provider Demographics
NPI:1861445009
Name:SCHERMOLY, MARTIN JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:JOSEPH
Last Name:SCHERMOLY
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 1:20805 W 151ST ST
Mailing Address - Street 2:STE # 224
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7249
Mailing Address - Country:US
Mailing Address - Phone:913-782-8300
Mailing Address - Fax:913-782-1574
Practice Address - Street 1:20805 W 151ST ST
Practice Address - Street 2:STE # 224
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7249
Practice Address - Country:US
Practice Address - Phone:913-782-8300
Practice Address - Fax:913-782-1574
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0421061207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100208130CMedicaid
KS100208130CMedicaid
D93572Medicare UPIN