MEDICARE: DR. MARCHYARN MAHATHANARUK D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	DR.0054219	CO

General Provider Information

NPI Number	:	1265674287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCHYARN MAHATHANARUK D.O.

Provider Business Mailing Address
First Line	:	PO BOX 800022
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64180-0022
Country	:	US
Telephone Number	:	800-953-0104
Fax Number	:	303-765-6670

Provider Business Practice Location Address
First Line	:	11700 W 2ND PL STE 225
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80228-1707
Country	:	US
Telephone Number	:	303-661-4100
Fax Number	:	720-321-8969

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2009
Last Update Date	:	01/31/2024

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