OrganizationActive
Age Reversal Technologies
NPI 1841594892 · Family Medicine Physician · Wichita, KS
Provider details
- NPI number
- 1841594892
- Entity type
- Organization
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Michael Shaw, Owner/President(316) 640-6253
- License
- 15-00115 (KS)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Practice location
2600 N Woodlawn Blvd
Wichita, KS 67220-2729
Phone: (316) 640-6253
Fax: (316) 858-2523
Approximate (ZIP-level) locationGet directions
Mailing address
2600 N Woodlawn Blvd
Wichita, KS 67220-2729
Registry dates
- Enumerated
- 2011-01-05
- Last updated
- 2011-09-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.