Healthcare Provider Details

I. General information

NPI: 1497394183
Provider Name (Legal Business Name): GRANT MICHAEL HUFFORD ATHLETIC TRAINER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 NALL AVE
OVERLAND PARK KS
66211-1206
US

IV. Provider business mailing address

17370 METRO AVE
BONNER SPRINGS KS
66012-7117
US

V. Phone/Fax

Practice location:
  • Phone: 913-426-1279
  • Fax:
Mailing address:
  • Phone: 913-426-1279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number24-00556
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: