Provider Demographics
NPI:1194088484
Name:HALL, MICAH (MD)
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S ANDOVER RD STE D
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-7926
Mailing Address - Country:US
Mailing Address - Phone:316-733-5120
Mailing Address - Fax:316-733-1280
Practice Address - Street 1:105 S ANDOVER RD STE D
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-7926
Practice Address - Country:US
Practice Address - Phone:316-733-5120
Practice Address - Fax:316-733-1280
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9407946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine