Provider Demographics
NPI:1700873932
Name:FERGUSON, MICHAEL J (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 741331
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1331
Mailing Address - Country:US
Mailing Address - Phone:913-469-0503
Mailing Address - Fax:913-469-5267
Practice Address - Street 1:801 N MUR LEN RD
Practice Address - Street 2:SUITE 211
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1794
Practice Address - Country:US
Practice Address - Phone:913-451-2253
Practice Address - Fax:913-338-1311
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2022-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0530649207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
553D258AMedicare ID - Type Unspecified
G30332Medicare UPIN