Healthcare Provider Details

I. General information

NPI: 1073613444
Provider Name (Legal Business Name): MARTIN L DE RUYTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 04/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD DEPT ANESTHESIOLOGY, MAIL STOP 1034
KANSAS CITY KS
66160
US

IV. Provider business mailing address

3901 RAINBOW BLVD DEPT ANESTHESIOLOGY, MAIL STOP 1034
KANSAS CITY KS
66160
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6670
  • Fax: 913-588-3365
Mailing address:
  • Phone: 913-588-6670
  • Fax: 913-588-3365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number04-30537
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number04-30537
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: