Healthcare Provider Details

I. General information

NPI: 1033108519
Provider Name (Legal Business Name): MAWD PATHOLOGY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9705 LENEXA DR
LENEXA KS
66215-1345
US

IV. Provider business mailing address

9705 LENEXA DR
LENEXA KS
66215-1345
US

V. Phone/Fax

Practice location:
  • Phone: 913-396-8509
  • Fax: 913-318-8378
Mailing address:
  • Phone: 913-396-8509
  • Fax: 913-318-8378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number26D0652254
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DAVID ERIC EWING
Title or Position: CEO
Credential:
Phone: 636-699-6027