Healthcare Provider Details

I. General information

NPI: 1215388632
Provider Name (Legal Business Name): MOTUS BIOLOGICS AND SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 W 119TH ST STE 250
OVERLAND PARK KS
66209-3724
US

IV. Provider business mailing address

5525 W 119TH ST STE 250
OVERLAND PARK KS
66209-3724
US

V. Phone/Fax

Practice location:
  • Phone: 913-808-5275
  • Fax: 913-257-5150
Mailing address:
  • Phone: 913-808-5275
  • Fax: 913-257-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number04-36559
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number04-36559
License Number StateKS

VIII. Authorized Official

Name: DR. LESLIE A MICHAUD
Title or Position: OWNER
Credential: M.D.
Phone: 913-808-5275