Provider Demographics
NPI:1538103940
Name:PRATER, MICHAEL TODD
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TODD
Last Name:PRATER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16121 PARADISE ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-2955
Mailing Address - Country:US
Mailing Address - Phone:913-897-1398
Mailing Address - Fax:
Practice Address - Street 1:16121 PARADISE ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66221-2955
Practice Address - Country:US
Practice Address - Phone:913-897-1398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0430500207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
39363011OtherBCBS OF KCMO
KSP00436177OtherRR MEDICARE
39363021OtherBCBS OF KC MO
KS200256170DMedicaid
MO207377300Medicaid
KSP00436002OtherRR MEDICARE
KS200256170CMedicaid
39363021OtherBCBS OF KC MO
KSP00436002OtherRR MEDICARE
KS763F692Medicare PIN