Individual
DR. MARTHA SUE FANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12300 METCALF AVE, OVERLAND PARK, KS 66213-1324
(913) 317-7485
Mailing address
PO BOX 411039, KANSAS CITY, MO 64141-1039
(913) 234-1350
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
04-26640
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01674018
BCBS KC MO GRP 01674018
KS
05
—
100333210C
—
KS
05
—
100333210E
—
KS
05
—
208531038
—
MO
01
—
24548068
BCBS KC MO
KS
01
—
24548088
BCBS KC MO
MO
01
—
930072754
RR MEDICARE GROUP CC8899
—
01
—
P00278183
RR MEDICARE GROUP DC6712
—
Enumeration date
08/03/2005
Last updated
06/29/2021
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