Provider Demographics
NPI:1487675971
Name:GUHR, MICHAEL TODD (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TODD
Last Name:GUHR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 COMMERCIAL CIR
Mailing Address - Street 2:
Mailing Address - City:WAMEGO
Mailing Address - State:KS
Mailing Address - Zip Code:66547-9690
Mailing Address - Country:US
Mailing Address - Phone:785-456-2207
Mailing Address - Fax:
Practice Address - Street 1:1704 COMMERCIAL CIR
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-9690
Practice Address - Country:US
Practice Address - Phone:785-456-2207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00849363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100426340BMedicaid
KS068002205OtherMEDICARE PTAN
KSP67969Medicare UPIN
KS100426340BMedicaid