Healthcare Provider Details

I. General information

NPI: 1174555957
Provider Name (Legal Business Name): LARRY KURT MIDYETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12330 METCALF AVE STE. 500
OVERLAND PARK KS
66213-1324
US

IV. Provider business mailing address

10550 QUIVIRA RD STE 520
OVERLAND PARK KS
66215-2307
US

V. Phone/Fax

Practice location:
  • Phone: 913-317-3170
  • Fax: 913-317-3192
Mailing address:
  • Phone: 913-310-0482
  • Fax: 913-894-1330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number2001016013
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number04-29123
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: