Provider Demographics
NPI:1801900311
Name:WEST, CHARLES MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:MICHAEL
Last Name:WEST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 SW 38TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66610-1252
Mailing Address - Country:US
Mailing Address - Phone:785-295-9753
Mailing Address - Fax:785-233-1817
Practice Address - Street 1:5885 SW 29TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2466
Practice Address - Country:US
Practice Address - Phone:785-272-1903
Practice Address - Fax:785-272-5711
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0420377207RI0200X
KS04-20377207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSD09137Medicare UPIN
KS100182840AMedicaid