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NPI Code Detail

MEDICARE: MICHAELYN MICK LRT

MEDICARE: MICHAELYN MICK LRT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician2205923KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12205923OTHERKSARRT

General Provider Information

NPI Number : 1013531458
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAELYN MICK LRT
Provider Business Mailing Address
First Line : 508 N STARK ST
Second Line :
City : BENNINGTON
State : KS
Zip : 67422-9429
Country : US
Telephone Number : 785-416-0033
Fax Number :
Provider Business Practice Location Address
First Line : 2265 S 9TH ST
Second Line :
City : SALINA
State : KS
Zip : 67401-7308
Country : US
Telephone Number : 785-452-6002
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2020
Last Update Date : 06/02/2020

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