Provider Demographics
NPI:1174555957
Name:MIDYETT, LARRY KURT (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:KURT
Last Name:MIDYETT
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10550 QUIVIRA RD STE 520
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2307
Mailing Address - Country:US
Mailing Address - Phone:913-310-0482
Mailing Address - Fax:913-894-1330
Practice Address - Street 1:12330 METCALF AVE
Practice Address - Street 2:STE. 500
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1324
Practice Address - Country:US
Practice Address - Phone:913-317-3170
Practice Address - Fax:913-317-3192
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2017-10-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO20010160132080P0205X
KS04-291232080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208309708Medicaid
KSG93000010Medicare PIN
MO208309708Medicaid