Provider Demographics
NPI:1922006212
Name:CARTER, MICHAEL W (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:CARTER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:KS
Mailing Address - Zip Code:66771-4044
Mailing Address - Country:US
Mailing Address - Phone:620-449-2582
Mailing Address - Fax:620-449-2587
Practice Address - Street 1:200 CARROLL ST
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:KS
Practice Address - Zip Code:66771-4044
Practice Address - Country:US
Practice Address - Phone:620-449-2582
Practice Address - Fax:620-449-2587
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00512363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS42591OtherBCBS
KS100362330BMedicaid
KS100362330BMedicaid
KS42591OtherBCBS