Provider Demographics
NPI:1407840739
Name:MICHAEL M VESALI MD P A
Entity Type:Organization
Organization Name:MICHAEL M VESALI MD P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:VESALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-264-7707
Mailing Address - Street 1:818 N EMPORIA ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3729
Mailing Address - Country:US
Mailing Address - Phone:316-264-7707
Mailing Address - Fax:316-264-7717
Practice Address - Street 1:818 N EMPORIA ST
Practice Address - Street 2:SUITE 308
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3729
Practice Address - Country:US
Practice Address - Phone:316-264-7707
Practice Address - Fax:316-264-7717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS07-07825442084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110932Medicare ID - Type Unspecified