Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 12-00272 | KS |
NPI | 1598731002 |
---|---|
Provider Name | Dr. Brian K Haith |
First Address | Overland Park, KS 66207-0310 |
Second Address | Leawood, KS 66211-1701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 28/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22357013 | BLUE CROSS BLUE SHIELD (01) | |
308946508 | (05) | MO |
480032592 | RRPTAN (01) |