Organization · NPI-2

Age Reversal Technologies

Family Medicine · Wichita, KS

NPI number1841594892
StatusActive
Last updated in NPPESSep 30, 2011

Details

NPI
1841594892
Entity type
Organization (NPI-2)
Legal business name
Age Reversal Technologies
Organization subpart
No
Enumeration date
Jan 5, 2011
Last updated
Sep 30, 2011

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine15-00115KSYes
207R00000X Internal Medicine15-00115KS

Practice location

2600 N Woodlawn Blvd
Wichita, KS 67220-2729

Phone 316-640-6253 · Fax 316-858-2523

Mailing address

2600 N Woodlawn Blvd
Wichita, KS 67220-2729

Phone 316-640-6253 · Fax 316-858-2523

Authorized official

Michael N Shaw
Owner/President
3166406253

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