Basic Information
| Provider Information | |||||||||
| NPI: | 1023018827 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SABOLOVIC | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.S.P.T., M.T.C. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 5799 BROADMOOR ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MISSION | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662022403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133845600 | ||||||||
| FaxNumber: | 9133840719 | ||||||||
| Practice Location | |||||||||
| Address1: | 5799 BROADMOOR ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MISSION | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662022403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133845600 | ||||||||
| FaxNumber: | 9133840719 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2005 | ||||||||
| LastUpdateDate: | 01/31/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 11-02336 | KS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 2001018689 | MO | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 501071 | 01 | PHCS | OTHER | 731060 | 01 | HEALTHCARE PREFERRED | OTHER | 650019070 | 01 | KS | MEDICARE RAILROAD | OTHER | T66E306 | 01 | KS | MEDICARE B - KS | OTHER | 24598014 | 01 | BLUE CROSS BLUE SHIELD KC | OTHER | 43181441066202A002 | 01 | KS | TRICARE - KS | OTHER | 24598 | 01 | PREFERRED HEALTH PROFESS | OTHER | 4000127 | 01 | MULTIPLAN | OTHER | 8271336 | 01 | AETNA | OTHER | T66E306A | 01 | MO | MEDICARE B - MO | OTHER | 43181441064155A004 | 01 | MO | TRICARE - MO | OTHER | 534021 | 01 | KS | BLUE CROSS BLUE SHIELD KS | OTHER | 1239683 | 01 | FIRST HEALTH NETWORK | OTHER | 440238 | 01 | HEALTHLINK | OTHER |