Organization
OPTUM MEDICAL GROUP P A
Active
Other names
Optum
Organization subpart
No
Provider details
NPI number
Authorized official
EMILY CASTILLO (MEDICAL STAFF MANAGER)
(702) 480-2550
Entity
Organization
Contact information
Practice address
6860 W 115TH ST, OVERLAND PARK, KS 66211-2457
(913) 253-0601
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(702) 579-3253
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
06/21/2022
Last updated
10/27/2023
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