Provider Demographics
NPI:1396952990
Name:BRIAN K. HAITH DPM PA
Entity type:Organization
Organization Name:BRIAN K. HAITH DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HAITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM PA
Authorized Official - Phone:913-648-7440
Mailing Address - Street 1:4225 W. 107TH ST. #7310
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207
Mailing Address - Country:US
Mailing Address - Phone:913-648-7440
Mailing Address - Fax:913-648-7440
Practice Address - Street 1:4319 W 111TH TER
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1701
Practice Address - Country:US
Practice Address - Phone:913-648-7440
Practice Address - Fax:913-648-7440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD3689OtherRRPTAN
MOP22357013OtherBLUE CROSS BLUE SHIELD
MO504447202Medicaid
KSS480000AMedicare PIN
MOS480000Medicare PIN