Provider Demographics
NPI:1578586830
Name:MORALES, MANUEL (MD)
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:
Last Name:MORALES
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 1:4707 COLLEGE BLVD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1603
Mailing Address - Country:US
Mailing Address - Phone:913-663-3000
Mailing Address - Fax:913-663-1115
Practice Address - Street 1:4707 COLLEGE BLVD
Practice Address - Street 2:SUITE 213
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1603
Practice Address - Country:US
Practice Address - Phone:913-663-3000
Practice Address - Fax:913-663-1115
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-183272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS04-18327OtherKANSAS LICENSE
KS04-18327OtherKANSAS LICENSE
AM8994825OtherDEA NUMBER