Provider Demographics
NPI:1093779605
Name:MICHAEL S FEDOTIN & B WILLIAM GINSBERG PA
Entity Type:Organization
Organization Name:MICHAEL S FEDOTIN & B WILLIAM GINSBERG PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:E
Authorized Official - Last Name:FIEDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-333-5424
Mailing Address - Street 1:2330 E MEYER BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-1132
Mailing Address - Country:US
Mailing Address - Phone:816-333-5424
Mailing Address - Fax:816-822-0870
Practice Address - Street 1:2330 E MEYER BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1132
Practice Address - Country:US
Practice Address - Phone:816-333-5424
Practice Address - Fax:816-822-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP9085OtherRR MEDICARE
MO509749701Medicaid
CP9085OtherRR MEDICARE