Provider Demographics
NPI:1760488407
Name:MORE, MICHAEL D (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:MORE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2029 BLUEGRASS CIR
Mailing Address - Street 2:STE 200
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-7368
Mailing Address - Country:US
Mailing Address - Phone:307-778-7666
Mailing Address - Fax:307-632-4465
Practice Address - Street 1:2029 BLUEGRASS CIR
Practice Address - Street 2:STE 200
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-7368
Practice Address - Country:US
Practice Address - Phone:307-778-7666
Practice Address - Fax:307-632-4465
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYW59213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY311541OtherBLUE SHIELD
WY103786200Medicaid
WY311541OtherBLUE SHIELD
WY103786200Medicaid
4523560001Medicare NSC