Provider Demographics
NPI:1093773095
Name:WAXMAN, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:WAXMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 PROSPECT AVENUE
Mailing Address - Street 2:T303
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132
Mailing Address - Country:US
Mailing Address - Phone:816-333-1919
Mailing Address - Fax:816-361-1930
Practice Address - Street 1:6420 PROSPECT AVENUE
Practice Address - Street 2:T303
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132
Practice Address - Country:US
Practice Address - Phone:816-333-1919
Practice Address - Fax:816-361-1930
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1E71207RP1001X
KS0417387207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100206310 BMedicaid
KS100206310DMedicaid
KS100206310 CMedicaid
KS100206310AMedicaid
MO202423208Medicaid
KS100206310DMedicaid
KSKA1441002Medicare PIN
C51617Medicare UPIN
MOP005466Medicare PIN
MOP00375112Medicare PIN
KS100206310AMedicaid
KS100206310 BMedicaid