Provider Demographics
NPI:1366714354
Name:MARINE, CLIFFORD S (MD)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:S
Last Name:MARINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 W 110TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2372
Mailing Address - Country:US
Mailing Address - Phone:800-881-0722
Mailing Address - Fax:
Practice Address - Street 1:7500 W 110TH ST
Practice Address - Street 2:SUITE 500
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2372
Practice Address - Country:US
Practice Address - Phone:800-881-0722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-21049174400000X
MOR9H39174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist