Provider Demographics
NPI:1114074630
Name:MIDWESTERN ENDOCRINOLOGY, P.A.
Entity Type:Organization
Organization Name:MIDWESTERN ENDOCRINOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-451-9888
Mailing Address - Street 1:5401 COLLEGE BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1923
Mailing Address - Country:US
Mailing Address - Phone:913-451-9888
Mailing Address - Fax:913-451-2651
Practice Address - Street 1:5401 COLLEGE BLVD
Practice Address - Street 2:STE 110
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1923
Practice Address - Country:US
Practice Address - Phone:913-451-9888
Practice Address - Fax:913-451-2651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS497142OtherBLUE CROSS BLUE SHIELD
KSCS4205OtherRALROAD MEDICARE
KSCS4205OtherRALROAD MEDICARE