Healthcare Provider Details

I. General information

NPI: 1760211346
Provider Name (Legal Business Name): MIDWEST SPECIALTY CLINICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11881 W 112TH ST
OVERLAND PARK KS
66210-2717
US

IV. Provider business mailing address

11881 W 112TH ST
OVERLAND PARK KS
66210-2717
US

V. Phone/Fax

Practice location:
  • Phone: 913-754-3275
  • Fax: 913-754-3276
Mailing address:
  • Phone: 913-754-3275
  • Fax: 913-754-3276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RAJIV DANG
Title or Position: MANAGER
Credential:
Phone: 913-486-1099