Organization
IMPACT ORTHOPEDICS & SPORTS MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL GABRIEL AZZAM MD (OWNER)
(913) 906-8640
Entity
Organization
Contact information
Practice address
5200 W 94TH TER STE 113, PRAIRIE VILLAGE, KS 66207-2522
(913) 906-8640
(913) 906-8682
Mailing address
5200 W 94TH TER STE 113, PRAIRIE VILLAGE, KS 66207-2522
(913) 906-8640
(913) 906-8682
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
04/05/2021
Last updated
12/24/2021
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