Provider Demographics
NPI:1376694927
Name:DAVOREN, MICHAEL P (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:DAVOREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:20375 W 151ST ST
Mailing Address - Street 2:SUITE 463
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7218
Mailing Address - Country:US
Mailing Address - Phone:913-782-8577
Mailing Address - Fax:913-782-2616
Practice Address - Street 1:20375 W 151ST ST
Practice Address - Street 2:SUITE 463
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7218
Practice Address - Country:US
Practice Address - Phone:913-782-8577
Practice Address - Fax:913-782-2616
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2014-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0425580208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00067790OtherRAILROAD MEDICARE
KS100421010CMedicaid
32810013OtherBCBS OF KANSAS CITY
7357335OtherAETNA
KS033D00057Medicare PIN
H60255Medicare UPIN