Healthcare Provider Details

I. General information

NPI: 1205313566
Provider Name (Legal Business Name): MIDWEST ORTHOPEDIC NETWORK KANSAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 W 143RD STREET
OVERLAND PARK KS
66223
US

IV. Provider business mailing address

710 N DEARBORN ST
CHICAGO IL
60654-5900
US

V. Phone/Fax

Practice location:
  • Phone: 312-951-8200
  • Fax: 312-981-1293
Mailing address:
  • Phone: 312-951-8200
  • Fax: 312-981-1293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ROSEMARIE ISAILY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 312-951-8200