MEDICARE: ETHAN HUNT

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	94-12704	KS

General Provider Information

NPI Number	:	1598606154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETHAN HUNT

Provider Business Mailing Address
First Line	:	3901 RAINBOW BLVD # MS 3045
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-8500
Country	:	US
Telephone Number	:	913-588-1227
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 RAINBOW BLVD # MS 3045
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-8500
Country	:	US
Telephone Number	:	913-588-1227
Fax Number	:

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

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	06/15/2026

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Directions to “ ETHAN HUNT ” Practice Location

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