Provider Demographics
NPI:1699712950
Name:EASTER, MICHAEL R (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:EASTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10100 E SHANNON WOODS ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-4104
Mailing Address - Country:US
Mailing Address - Phone:316-219-8299
Mailing Address - Fax:316-219-5899
Practice Address - Street 1:10100 E SHANNON WOODS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-4104
Practice Address - Country:US
Practice Address - Phone:316-219-8299
Practice Address - Fax:316-219-5899
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00207363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS042939OtherBLUE SHIELD
KS100424670BMedicaid
KS502180OtherFIRST GUARD
KS14012OtherPREFERRED HEALTH SYSTEMS
970028115OtherR. R. MEDICARE
KS14012OtherPREFERRED HEALTH SYSTEMS