Healthcare Provider Details

I. General information

NPI: 1952485583
Provider Name (Legal Business Name): MICHAEL F LAW PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 DELAWARE ST
WINCHESTER KS
66097-4003
US

IV. Provider business mailing address

408 DELAWARE ST
WINCHESTER KS
66097-4003
US

V. Phone/Fax

Practice location:
  • Phone: 913-343-5398
  • Fax:
Mailing address:
  • Phone: 913-343-5398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1500090
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: