Provider Demographics
NPI:1518932250
Name:POPE, MICHELLE J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:J
Last Name:POPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:J
Other - Last Name:MAUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2214 CANTERBURY DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2375
Mailing Address - Country:US
Mailing Address - Phone:785-623-2360
Mailing Address - Fax:785-623-2371
Practice Address - Street 1:2214 CANTERBURY DR
Practice Address - Street 2:SUITE 204
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2375
Practice Address - Country:US
Practice Address - Phone:785-623-2360
Practice Address - Fax:785-623-2371
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-30499208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSI34485Medicare UPIN
KS104837Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #