Individual
DR. MARK LAVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19609 E 9TH ST S, INDEPENDENCE, MO 64056-3088
(816) 796-1412
(816) 796-3398
Mailing address
14003 BOND ST, OVERLAND PARK, KS 66221-2830
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
R3P61
MO
2085R0202X
Diagnostic Radiology Physician
04-18135
KS
2085R0202X
Diagnostic Radiology Physician
Primary
R3P61
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00152876
RR MEDICARE
MS
01
—
P00152929
RR MEDICARE
KS
Enumeration date
03/07/2006
Last updated
03/13/2008
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