Provider Demographics
NPI:1083821904
Name:MICHAEL N. FINE, DPM, PC
Entity Type:Organization
Organization Name:MICHAEL N. FINE, DPM, PC
Other - Org Name:FINE FOOT CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:FINE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:816-455-8900
Mailing Address - Street 1:2700 CLAY EDWARDS DR STE 360
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3270
Mailing Address - Country:US
Mailing Address - Phone:816-455-8900
Mailing Address - Fax:816-455-8901
Practice Address - Street 1:2700 CLAY EDWARDS DR STE 360
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3270
Practice Address - Country:US
Practice Address - Phone:816-455-8900
Practice Address - Fax:816-455-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO679213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO308093905Medicaid
MO22440035OtherBCBS ID
MOCJ8263OtherRAILROAD MEDICARE
MO1033147277OtherTYPE 1 NPI
MOU49909Medicare UPIN
MOK630000Medicare ID - Type UnspecifiedMEDICARE ID