Provider Demographics
NPI:1194914713
Name:LAWRENCE M HOUSTON , MD CHARTERED
Entity type:Organization
Organization Name:LAWRENCE M HOUSTON , MD CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:MORLEY
Authorized Official - Last Name:HOUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-383-0711
Mailing Address - Street 1:10730 NALL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1206
Mailing Address - Country:US
Mailing Address - Phone:913-383-0711
Mailing Address - Fax:
Practice Address - Street 1:10730 NALL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1206
Practice Address - Country:US
Practice Address - Phone:913-383-0711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSC50365Medicare UPIN
KS0004186Medicare PIN