Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 01-05158 | KS |
Y | 213ER0200X | Radiology | 01-05158 | KS |
NPI | 1245610260 |
---|---|
Provider Name | Dr. Gary Michael Whitehead |
First Address | Overland Park, KS 66210-1613 |
Second Address | Overland Park, KS 66210-1613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2015 |
Last Update Date | 04/06/2015 |