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General NPI Number Information
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NPI Number | 1699712950
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Entity Type | Individual
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Provider Name | MICHAEL R. EASTER PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 04/06/2017
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Provider Practice Location Address
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Address Line | 10100 E SHANNON WOODS ST SUITE 100
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City | WICHITA
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State | KS
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Zip | 67226-4104
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Country | US
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Telephone | 316-219-8299
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Fax | 316-219-5899
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Provider Business Mailing Address
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Address Line | 10100 E SHANNON WOODS ST SUITE 100
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City | WICHITA
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State | KS
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Zip | 67226-4104
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Country | US
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Telephone | 316-219-8299
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Fax | 316-219-5899
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 15-00207
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License Number State | KS
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