Provider Demographics
NPI:1629368089
Name:THORS, AXEL (DO)
Entity Type:Individual
Prefix:DR
First Name:AXEL
Middle Name:
Last Name:THORS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 NALL AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1299
Mailing Address - Country:US
Mailing Address - Phone:913-574-0586
Mailing Address - Fax:913-274-3499
Practice Address - Street 1:10700 NALL AVE STE 300
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1299
Practice Address - Country:US
Practice Address - Phone:913-574-0586
Practice Address - Fax:913-274-3499
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-39724208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30004212330001Medicaid