MEDICARE: WEXLER FAMILY PSYCHIATRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	0533750	KS

General Provider Information

NPI Number	:	1629510417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEXLER FAMILY PSYCHIATRY

Provider Business Mailing Address
First Line	:	12306 PAWNEE LN
Second Line	:
City	:	LEAWOOD
State	:	KS
Zip	:	66209-1407
Country	:	US
Telephone Number	:	913-948-0688
Fax Number	:	913-261-9634

Provider Business Practice Location Address
First Line	:	4203 BOOTH ST
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66103-3116
Country	:	US
Telephone Number	:	913-948-0688
Fax Number	:	913-261-9634

Authorized Official
Title or Position	:	PHYSICAIN
Name	:	DR. MICAELA P WEXLER
Credential	:	D.O.
Telephone Number	:	913-948-0688

Provider Enumeration Date	:	11/09/2016
Last Update Date	:	11/09/2016

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