Healthcare Provider Details

I. General information

NPI: 1477513596
Provider Name (Legal Business Name): MICHAEL M TALTY P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 N BURKARTH RD
WARRENSBURG MO
64093-9303
US

IV. Provider business mailing address

5101 COLLEGE BLVD
LEAWOOD KS
66211-1614
US

V. Phone/Fax

Practice location:
  • Phone: 660-747-5444
  • Fax: 816-875-2597
Mailing address:
  • Phone: 913-721-3387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2021042806
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: