Individual
DR. MARLA R ULLOM-MINNICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
200 EAST PACK, MOUNDRIDGE, KS 67107
(620) 345-6322
(620) 345-3038
Mailing address
200 EAST PACK, MOUNDRIDGE, KS 67107-0640
(620) 345-6322
(620) 345-3038
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0424208
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02668
PREFERRED HEALTH SYSTEMS
KS
01
—
049108
BLUE CROSS/BLUE SHIELD
KS
01
—
460686
CHILDRENS MERCY FAMILY
KS
Enumeration date
06/16/2005
Last updated
07/08/2007
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