Provider Demographics
NPI:1952485583
Name:LAW, MICHAEL F (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:LAW
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 1:408 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KS
Mailing Address - Zip Code:66097-4003
Mailing Address - Country:US
Mailing Address - Phone:913-343-5398
Mailing Address - Fax:
Practice Address - Street 1:408 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KS
Practice Address - Zip Code:66097-4003
Practice Address - Country:US
Practice Address - Phone:913-343-5398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500090363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100345880FMedicaid
1005400OtherNCCPA
1005400OtherNCCPA
KS763000005Medicare PIN