Provider Demographics
NPI:1245308329
Name:MARTIN, PHILIP EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:EUGENE
Last Name:MARTIN
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 1:6815 HILLTOP RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-3551
Mailing Address - Country:US
Mailing Address - Phone:913-632-9600
Mailing Address - Fax:913-632-9659
Practice Address - Street 1:6815 HILLTOP RD
Practice Address - Street 2:STE 100
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66226
Practice Address - Country:US
Practice Address - Phone:913-632-9600
Practice Address - Fax:913-632-9695
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0421167207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100135700BMedicaid
D05374Medicare UPIN
C485743Medicare ID - Type Unspecified