Healthcare Provider Details

I. General information

NPI: 1427000900
Provider Name (Legal Business Name): MICHAEL W SHULL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 E SPRUCE ST
GARDEN CITY KS
67846
US

IV. Provider business mailing address

311 E SPRUCE ST
GARDEN CITY KS
67846
US

V. Phone/Fax

Practice location:
  • Phone: 620-275-3730
  • Fax:
Mailing address:
  • Phone: 620-275-3730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number05-22568
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: