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Individual
TED I HO
Active
Individual
TED I HO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
04-23751
KS
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
0423751
KS
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
04-23751
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057809
BCBS
KS
05
—
100141500B
—
KS
01
—
220029000
RAILROAD MEDICARE
KS
Enumeration date
01/21/2006
Last updated
08/05/2015
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