Provider Demographics
NPI:1508937228
Name:MIDWEST PHYSIATRISTS, PA
Entity Type:Organization
Organization Name:MIDWEST PHYSIATRISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HONAFIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-681-2420
Mailing Address - Street 1:9415 E HARRY ST STE 602
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-5082
Mailing Address - Country:US
Mailing Address - Phone:316-681-2420
Mailing Address - Fax:316-681-3561
Practice Address - Street 1:9415 E HARRY ST STE 602
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-5082
Practice Address - Country:US
Practice Address - Phone:316-681-2420
Practice Address - Fax:316-681-3561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-24294174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS016879Medicare ID - Type UnspecifiedMIDWESTPHYSIATRISTS, PA