Healthcare Provider Details

I. General information

NPI: 1669715009
Provider Name (Legal Business Name): MICHAEL GREGORY YOUNG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2013
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16990 W 86TH ST STE 200
LENEXA KS
66219-4506
US

IV. Provider business mailing address

16990 W 86TH ST STE 200
LENEXA KS
66219-4506
US

V. Phone/Fax

Practice location:
  • Phone: 913-632-9810
  • Fax: 913-632-9828
Mailing address:
  • Phone: 913-632-9810
  • Fax: 913-632-9828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number05-53385
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number20A13871
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: