Healthcare Provider Details

I. General information

NPI: 1356390546
Provider Name (Legal Business Name): MICHAEL CRAIG STILES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 W 129TH ST
OVERLAND PARK KS
66213-2624
US

IV. Provider business mailing address

7200 W 129TH ST
OVERLAND PARK KS
66213-2624
US

V. Phone/Fax

Practice location:
  • Phone: 913-897-9299
  • Fax: 914-897-3031
Mailing address:
  • Phone: 913-897-9299
  • Fax: 914-897-3031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0421479
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberR3N76
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number04-21479
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: