Healthcare Provider Details

I. General information

NPI: 1801900311
Provider Name (Legal Business Name): CHARLES MICHAEL WEST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5885 SW 29TH ST
TOPEKA KS
66614-2466
US

IV. Provider business mailing address

5700 SW 38TH ST
TOPEKA KS
66610-1252
US

V. Phone/Fax

Practice location:
  • Phone: 785-272-1903
  • Fax: 785-272-5711
Mailing address:
  • Phone: 785-295-9753
  • Fax: 785-233-1817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-20377
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0420377
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: