Provider Demographics
NPI:1386838605
Name:BIRDSELL, MICHELLE RENEE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEE
Last Name:BIRDSELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 N BELLEVIEW AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-2188
Mailing Address - Country:US
Mailing Address - Phone:913-338-0400
Mailing Address - Fax:816-459-7885
Practice Address - Street 1:4500 COLLEGE BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1799
Practice Address - Country:US
Practice Address - Phone:913-338-0400
Practice Address - Fax:913-338-0428
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070016622084P0800X
KST-014482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry