Provider Demographics
NPI:1194835710
Name:OPOLE, REBECCA W (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:W
Last Name:OPOLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW BLVD, 4070 DELP, MS 4017
Mailing Address - Street 2:KANSAS UNIVERSITY PHYSICIANS INC
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-2500
Mailing Address - Fax:
Practice Address - Street 1:3901 RAINBOW BLVD, 6040 DELP, MS 1020
Practice Address - Street 2:KANSAS UNIVERSITY PHYSICIANS INC
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-3974
Practice Address - Fax:913-588-6055
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-30856207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209374909Medicaid
KS925212OtherFIRSTGUARD
KS200271050AMedicaid
MO34564014OtherBCBS KANSAS CITY
I20185Medicare UPIN
KS011D431AMedicare ID - Type Unspecified
MO209374909Medicaid