Provider Demographics
NPI:1225019789
Name:ROONEY, MICHAEL N (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:N
Last Name:ROONEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-6411
Mailing Address - Country:US
Mailing Address - Phone:620-227-1371
Mailing Address - Fax:620-227-1208
Practice Address - Street 1:2020 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-6411
Practice Address - Country:US
Practice Address - Phone:620-227-1371
Practice Address - Fax:620-227-1208
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0521670208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
E63933Medicare UPIN
KS039668ROMedicare ID - Type Unspecified