Provider Demographics
NPI:1932152170
Name:MANN, MARK DOUGLAS (PA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:DOUGLAS
Last Name:MANN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 7411931
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-1931
Mailing Address - Country:US
Mailing Address - Phone:816-931-3312
Mailing Address - Fax:816-531-9862
Practice Address - Street 1:4330 WORNALL RD STE 50
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3201
Practice Address - Country:US
Practice Address - Phone:816-931-3312
Practice Address - Fax:816-531-9862
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2025-06-17
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Provider Licenses
StateLicense IDTaxonomies
KS15363A00000X
MO2009009267363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant