Basic Information
| Provider Information | |||||||||
| NPI: | 1730156605 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KINSMAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 830 SW MULVANE ST | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666061654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852708625 | ||||||||
| FaxNumber: | 7852708624 | ||||||||
| Practice Location | |||||||||
| Address1: | 830 SW MULVANE ST | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666061654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852708625 | ||||||||
| FaxNumber: | 7852708624 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2006 | ||||||||
| LastUpdateDate: | 10/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 15-00827 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 100414580B | 05 | KS | MEDICAID | 100414580E | 05 | KS | MEDICAID | P00630820 | 01 | KS | RR MEDICARE | OTHER |