Healthcare Provider Details

I. General information

NPI: 1164311742
Provider Name (Legal Business Name): BIRCHES HEALTH MEDICAL GROUP MIDWEST, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S ASHLEY DR STE 600
TAMPA FL
33602-5300
US

IV. Provider business mailing address

4601 E DOUGLAS AVE STE 150
WICHITA KS
67218-1032
US

V. Phone/Fax

Practice location:
  • Phone: 833-483-3838
  • Fax: 844-831-4571
Mailing address:
  • Phone: 833-483-3838
  • Fax: 844-831-4571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: ELLIOTT RAPAPORT
Title or Position: AUTHORIZED SIGNATORY
Credential:
Phone: 917-843-8445