Provider Demographics
NPI:1457589319
Name:TERESA VARANKA MD LLC
Entity Type:Organization
Organization Name:TERESA VARANKA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-663-3000
Mailing Address - Street 1:4707 COLLEGE BLVD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1933
Mailing Address - Country:US
Mailing Address - Phone:913-663-3000
Mailing Address - Fax:913-663-1115
Practice Address - Street 1:4707 COLLEGE BLVD
Practice Address - Street 2:SUITE 213
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1933
Practice Address - Country:US
Practice Address - Phone:913-663-3000
Practice Address - Fax:913-663-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-20217103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0000086Medicare PIN
C52112Medicare UPIN