Provider Demographics
NPI:1295943165
Name:MIDWEST ORTHOPEDICS FOOT AND ANKLE PC
Entity type:Organization
Organization Name:MIDWEST ORTHOPEDICS FOOT AND ANKLE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BONAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-941-7785
Mailing Address - Street 1:11237 NALL AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1655
Mailing Address - Country:US
Mailing Address - Phone:913-469-3690
Mailing Address - Fax:913-469-3692
Practice Address - Street 1:11237 NALL AVE STE 130
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1655
Practice Address - Country:US
Practice Address - Phone:913-469-3690
Practice Address - Fax:913-469-3692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107003174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207754219Medicaid
MOF96678Medicare UPIN
MO207754219Medicaid
MOT007342Medicare ID - Type Unspecified
5557470001Medicare NSC