=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003853763
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE L DEW MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2006
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9119 W 74TH ST STE 350
-----------------------------------------------------
City | MERRIAM
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66204-2268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-632-9400
-----------------------------------------------------
Fax | 913-632-9444
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9119 W 74TH ST STE 350
-----------------------------------------------------
City | MERRIAM
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66204-2268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-632-9400
-----------------------------------------------------
Fax | 913-632-9444
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 04-31781
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 2002002467
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------