MEDICARE: DR. MICHAEL JOHN FARRIS M.D.

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
1	207P00000X	Emergency Medicine Physician	0430692	KS
2	207P00000X	Emergency Medicine Physician	E-14204	AR
3	207P00000X	Emergency Medicine Physician	2014009219	MO
4	207Q00000X	Family Medicine Physician	0430692	KS
5	207Q00000X	Family Medicine Physician	E-14204	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2500021669	OTHER	MO	BNDD
2	2014009219	OTHER	MO	STATE LICENSE
3	0430692	OTHER	KS	STATE LICENSE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801891387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JOHN FARRIS M.D.

Provider Business Mailing Address
First Line	:	1411 13000 RD
Second Line	:
City	:	ALTAMONT
State	:	KS
Zip	:	67330-9305
Country	:	US
Telephone Number	:	620-423-2051
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 W HICKORY ST
Second Line	:
City	:	NEOSHO
State	:	MO
Zip	:	64850
Country	:	US
Telephone Number	:	417-455-4276
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	03/07/2023

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Directions to “ DR. MICHAEL JOHN FARRIS M.D.” Practice Location

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