Provider Demographics
NPI:1578672481
Name:OPOLE, ISAAC O (MD)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:O
Last Name:OPOLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3901 RAINBOW BLVD., 4070 DELP, MS 4017
Mailing Address - Street 2:KANSAS UNIVERSITY PHYSICIANS, INC.
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-2501
Mailing Address - Fax:913-588-3877
Practice Address - Street 1:3901 RAINBOW BLVD, 6040 DELP, MS 1020
Practice Address - Street 2:DIVISION OF GENERAL AND GERIATRIC MEDICINE, UNIVERSITY
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-6005
Practice Address - Fax:913-588-3877
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-06-20
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Provider Licenses
StateLicense IDTaxonomies
KS04-31556207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200353590AMedicaid
KS927877OtherFIRSTGUARD
MO208406306Medicaid
MO35923028OtherBCBS KANSAS CITY
I46411Medicare UPIN
KSP00282127Medicare ID - Type UnspecifiedRAILROAD MEDICARE
KS011E228AMedicare ID - Type Unspecified