Healthcare Provider Details

I. General information

NPI: 1821653247
Provider Name (Legal Business Name): JOSE PEREZ MARTELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JP MARTELL MD

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E 24TH ST
KANSAS CITY MO
64108-2776
US

IV. Provider business mailing address

1555 NE RICE RD
LEES SUMMIT MO
64086-5849
US

V. Phone/Fax

Practice location:
  • Phone: 816-966-0900
  • Fax: 816-416-7098
Mailing address:
  • Phone: 816-347-3069
  • Fax: 816-347-3200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number2024031505
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number73418
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number73418
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: