Healthcare Provider Details

I. General information

NPI: 1588758502
Provider Name (Legal Business Name): MARK J HAMBLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD MAIL STOP 3007
KANSAS CITY KS
66160
US

IV. Provider business mailing address

3901 RAINBOW BLVD MAIL STOP 3007
KANSAS CITY KS
66160
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6046
  • Fax: 913-588-4098
Mailing address:
  • Phone: 913-588-6046
  • Fax: 913-588-4098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberKS04-35034
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberKS04-35034
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: