Provider Demographics
NPI:1497742886
Name:GILLETT, MARK L (MD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:L
Last Name:GILLETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6807 W. 121ST ST.
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209
Mailing Address - Country:US
Mailing Address - Phone:913-522-0797
Mailing Address - Fax:913-469-5267
Practice Address - Street 1:6807 W. 121ST ST.
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66209
Practice Address - Country:US
Practice Address - Phone:913-356-1007
Practice Address - Fax:913-338-1311
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0424045207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5533316AMedicare ID - Type Unspecified
E51574Medicare UPIN