Provider Demographics
NPI:1952536864
Name:TODD, MARC ALAN (PA)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:ALAN
Last Name:TODD
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Gender:M
Credentials:PA
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Mailing Address - Street 1:9350 E 35TH ST N
Mailing Address - Street 2:STE 101
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2019
Mailing Address - Country:US
Mailing Address - Phone:316-265-1308
Mailing Address - Fax:316-265-4480
Practice Address - Street 1:9350 E 35TH ST N
Practice Address - Street 2:STE 101
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2019
Practice Address - Country:US
Practice Address - Phone:316-265-1308
Practice Address - Fax:316-265-4480
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2021-03-30
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Provider Licenses
StateLicense IDTaxonomies
KS15-00412363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical