Provider Demographics
NPI:1932136637
Name:HERWIG, MICHAEL RAY (RPA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RAY
Last Name:HERWIG
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 S SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4145
Mailing Address - Country:US
Mailing Address - Phone:785-823-2215
Mailing Address - Fax:785-823-7459
Practice Address - Street 1:520 S SANTA FE AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4190
Practice Address - Country:US
Practice Address - Phone:785-823-2215
Practice Address - Fax:785-823-7459
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSPA00144363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS010041Medicare ID - Type Unspecified