Provider Demographics
NPI:1356320287
Name:EVERSON, MICHAEL JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:EVERSON
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 1:8900 STATE LINE RD
Mailing Address - Street 2:STE 380
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206
Mailing Address - Country:US
Mailing Address - Phone:913-385-7252
Mailing Address - Fax:913-385-2412
Practice Address - Street 1:8900 STATE LINE RD
Practice Address - Street 2:STE 380
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206
Practice Address - Country:US
Practice Address - Phone:913-385-7252
Practice Address - Fax:913-385-2412
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04299722084P0800X
MO20040027662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
34353016OtherBCBS OF KC
A91D020BMedicare ID - Type Unspecified
A91D020Medicare ID - Type Unspecified
H83522Medicare UPIN
A91D020AMedicare ID - Type Unspecified