1063495992 NPI number — MR. LEONARD MICHAEL LITTLE PHD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063495992 NPI number — MR. LEONARD MICHAEL LITTLE PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LITTLE
Provider First Name:
LEONARD
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LITTLE
Provider Other First Name:
MICHAEL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1063495992
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5401 COLLEGE BLVD
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
LEAWOOD
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66211-1617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-339-6838
Provider Business Mailing Address Fax Number:
913-764-4160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5401 COLLEGE BLVD
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
LEAWOOD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66211-1617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-339-6838
Provider Business Practice Location Address Fax Number:
913-764-4160
Provider Enumeration Date:
11/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  00953 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 0542 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: KA2040124 . This is a "MEDICARE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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