Provider Demographics
NPI:1679684591
Name:GORTON, MICHAEL EARL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EARL
Last Name:GORTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 219672
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64121-9672
Mailing Address - Country:US
Mailing Address - Phone:816-407-5490
Mailing Address - Fax:816-407-5491
Practice Address - Street 1:2521 GLENN HENDREN DR
Practice Address - Street 2:SUITE 306
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3388
Practice Address - Country:US
Practice Address - Phone:816-407-5490
Practice Address - Fax:816-407-5491
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4P01208600000X, 2086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery