Provider Demographics
NPI:1831233592
Name:ANDERSON, MICHAEL W (PHD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W GREGORY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-1140
Mailing Address - Country:US
Mailing Address - Phone:816-361-0664
Mailing Address - Fax:816-361-0677
Practice Address - Street 1:10550 QUIVIRA RD
Practice Address - Street 2:SUITE 335
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2306
Practice Address - Country:US
Practice Address - Phone:913-599-3800
Practice Address - Fax:913-599-3817
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01662103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
21526011OtherBCBSKC INDIVIDUAL #
21526011OtherBCBSKC INDIVIDUAL #
P00026817Medicare ID - Type UnspecifiedRAILROAD MEDICARE #
J207685Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL #