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General NPI Number Information
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NPI Number | 1689034472
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Entity Type | Organization
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Legal Business Name | MID-AMERICA ORTHOPEDICS KC LLC
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 04/02/2019
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Provider Practice Location Address
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Address Line | 4940 W 137TH ST STE B
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City | LEAWOOD
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State | KS
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Zip | 66224
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Country | US
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Telephone | 913-232-9846
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Fax | 913-232-9817
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Provider Business Mailing Address
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Address Line | 4940 W 137TH ST STE B
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City | LEAWOOD
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State | KS
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Zip | 66224-3633
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Country | US
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Telephone | 913-232-9846
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Fax | 913-232-9817
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Authorized Official
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Title or Position | MD/CEO
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Name | PAT DO
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Credential | MD
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Telephone | 913-232-9846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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