Provider Demographics
NPI:1861638199
Name:JUSTICE, MICHAEL JASON (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JASON
Last Name:JUSTICE
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 1:2790 CLAY EDWARDS DR
Mailing Address - Street 2:SUITE #650
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3276
Mailing Address - Country:US
Mailing Address - Phone:816-459-7500
Mailing Address - Fax:816-459-9611
Practice Address - Street 1:203 NW RD MIZE ROAD
Practice Address - Street 2:SUITE #250
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014
Practice Address - Country:US
Practice Address - Phone:816-220-8727
Practice Address - Fax:816-220-8269
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008017228207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery