Provider Demographics
NPI:1407825599
Name:KODY, MICHAEL H (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:KODY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W 5TH AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2715
Mailing Address - Country:US
Mailing Address - Phone:509-344-2663
Mailing Address - Fax:509-624-9179
Practice Address - Street 1:601 W 5TH AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2715
Practice Address - Country:US
Practice Address - Phone:509-344-2663
Practice Address - Fax:509-624-9179
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028886174400000X
WA1068238207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0035776Medicaid
WA1408OtherGROUP HEALTH NW
IDKQ506OtherBLUE CROSS OF IDAHO
ID000010004256OtherREGENCE BLUE SHIELD OF ID
ID003783300Medicaid
WA4588KOOtherASURIS NW HEALTH
WA0149068OtherDEPT OF LABOR & INDUSTRIE
WA8929876OtherCRIME VICTIMS
ID44347OtherHMO BLUE
WA1068238Medicaid
WA200040944OtherRR MEDICARE
WA379109600OtherOWCP
GAB21408Medicare PIN
WA0149068OtherDEPT OF LABOR & INDUSTRIE
MT0035776Medicaid
WAG319213900Medicare PIN