Organization
MIDWEST PSYCHIATRIC PA
Active
Other names
Awakenings
Organization subpart
No
Provider details
NPI number
Authorized official
MAGDALEN GUSTILO (DIRECTOR OF PAYER RELATIONS)
(714) 568-7667
Entity
Organization
Contact information
Practice address
5300 W 94TH TER STE 200, PRAIRIE VILLAGE, KS 66207-2536
(913) 381-8555
(913) 677-2112
Mailing address
5300 W 94TH TER STE 200, PRAIRIE VILLAGE, KS 66207-2536
(913) 381-8555
(913) 677-2112
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
0427007
KS
2084P0802X
Addiction Psychiatry Physician
0427007
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100384540B
—
KS
05
—
203768908-A
—
MO
Enumeration date
05/09/2007
Last updated
06/05/2023
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