Provider Demographics
NPI:1497031967
Name:FOMBY, MICHAEL FRAZIER (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FRAZIER
Last Name:FOMBY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8550 MARSHALL DR STE 220
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1505
Mailing Address - Country:US
Mailing Address - Phone:816-942-8200
Mailing Address - Fax:913-495-3760
Practice Address - Street 1:373 W 101ST TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4498
Practice Address - Country:US
Practice Address - Phone:816-942-8200
Practice Address - Fax:913-495-3760
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0537168207R00000X
MO2020032506207R00000X
TXBP10040683390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program