Provider Demographics
NPI:1003003310
Name:WEST COLLEGE DERMATOLOGY & AESTHETICS, PA
Entity Type:Organization
Organization Name:WEST COLLEGE DERMATOLOGY & AESTHETICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HAAG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-888-3376
Mailing Address - Street 1:11041 HAUSER ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66210-3708
Mailing Address - Country:US
Mailing Address - Phone:913-888-3376
Mailing Address - Fax:913-888-3386
Practice Address - Street 1:11041 HAUSER ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66210-3708
Practice Address - Country:US
Practice Address - Phone:913-888-3376
Practice Address - Fax:913-888-3386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-25210207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSF85815Medicare UPIN
KSQ960000Medicare PIN