Basic Information
| Provider Information | |||||||||
| NPI: | 1558654392 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEMPEWOLF | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2861 NE INDEPENDENCE AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | LEES SUMMIT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640642379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165252840 | ||||||||
| FaxNumber: | 8165252841 | ||||||||
| Practice Location | |||||||||
| Address1: | 4940B W. 137TH ST. | ||||||||
| Address2: | |||||||||
| City: | LEAWOOD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9132329846 | ||||||||
| FaxNumber: | 9132329817 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2011 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 05-38785 | KS | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | 05-38785 | KS | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.