Healthcare Provider Details

I. General information

NPI: 1487064945
Provider Name (Legal Business Name): COLLIN HULL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 QUIVIRA RD
LENEXA KS
66215-3902
US

IV. Provider business mailing address

9040 QUIVIRA RD
LENEXA KS
66215-3902
US

V. Phone/Fax

Practice location:
  • Phone: 913-261-3153
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2020012515
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number34.013873
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number05-43007
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: