Healthcare Provider Details

I. General information

NPI: 1184622730
Provider Name (Legal Business Name): MIDWEST EAR NOSE AND THROAT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20375 W 151ST ST STE #106
OLATHE KS
66061
US

IV. Provider business mailing address

PO BOX 874480
KANSAS CITY MO
64187-0001
US

V. Phone/Fax

Practice location:
  • Phone: 913-764-2737
  • Fax: 913-764-7502
Mailing address:
  • Phone: 913-764-2737
  • Fax: 913-764-7502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateKS

VIII. Authorized Official

Name: BRIAN A METZ
Title or Position: PRESIDENT
Credential: MD
Phone: 913-764-2737