Provider Demographics
NPI:1083644942
Name:LASLEY, MICHAEL B (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:LASLEY
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 1:2501 E 13TH ST STE 7
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2764
Mailing Address - Country:US
Mailing Address - Phone:785-628-3217
Mailing Address - Fax:785-628-3372
Practice Address - Street 1:2501 E 13TH ST
Practice Address - Street 2:SUITE 7
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2764
Practice Address - Country:US
Practice Address - Phone:785-628-3217
Practice Address - Fax:785-628-3372
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-16661208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100085640AMedicaid
B68938Medicare UPIN
003248Medicare ID - Type Unspecified