Provider Demographics
NPI:1003843806
Name:MORGAN, MITCHELL A (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:A
Last Name:MORGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 S CLIFTON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2955
Mailing Address - Country:US
Mailing Address - Phone:316-462-1040
Mailing Address - Fax:316-462-1042
Practice Address - Street 1:1131 S CLIFTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2955
Practice Address - Country:US
Practice Address - Phone:316-462-1040
Practice Address - Fax:316-462-1042
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS23401207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F32131Medicare UPIN
KS1855OtherPHS
KS059908Medicare ID - Type Unspecified
KS100135970BMedicaid
KS059908OtherBCBS
KS100003OtherHPK
KS17018OtherCOVENTRY