Provider Demographics
NPI:1649205758
Name:MAYORGA MAY, ANGELA KAREN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:KAREN
Last Name:MAYORGA MAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:KAREN
Other - Last Name:MAYORGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5620 LEGLER ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-9665
Mailing Address - Country:US
Mailing Address - Phone:913-449-8343
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:MAIL STOP 4015
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-6412
Practice Address - Fax:913-588-6414
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-31917207R00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200383730AMedicaid
KSI56302Medicare UPIN