Provider Demographics
NPI:1922017300
Name:HAULMARK, RONALD D (RPAC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:D
Last Name:HAULMARK
Suffix:
Gender:M
Credentials:RPAC
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 12066
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-0066
Mailing Address - Country:US
Mailing Address - Phone:913-299-4966
Mailing Address - Fax:913-299-4205
Practice Address - Street 1:1150 N 75TH PL
Practice Address - Street 2:SUITE 200
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-3302
Practice Address - Country:US
Practice Address - Phone:913-299-2100
Practice Address - Fax:913-299-4205
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00261207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOC47E413Medicare ID - Type Unspecified
Q65476Medicare UPIN
MOC47E413AMedicare ID - Type Unspecified