Basic Information
| Provider Information | |||||||||
| NPI: | 1043316250 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDWEST MEDICAL SPECIALISTS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5330 N OAK TRFY | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641184699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164540666 | ||||||||
| FaxNumber: | 8164541694 | ||||||||
| Practice Location | |||||||||
| Address1: | 5330 N OAK TRFY | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641184699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164540666 | ||||||||
| FaxNumber: | 8164541694 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2006 | ||||||||
| LastUpdateDate: | 11/17/2016 | ||||||||
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| AuthorizedOfficialLastName: | KORANDA | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 8164540666 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology | 207N00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | CI8219 | 01 | MO | RAILROAD MEDICARE | OTHER |