Provider Demographics
NPI:1851340095
Name:MAIN, MICHAEL L (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:MAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:MAILSTOP 400S
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131
Mailing Address - Country:US
Mailing Address - Phone:816-502-7117
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:4330 WORNALL RD
Practice Address - Street 2:SUITE 2000
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5939
Practice Address - Country:US
Practice Address - Phone:816-931-1883
Practice Address - Fax:816-756-3645
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2020-09-08
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Provider Licenses
StateLicense IDTaxonomies
MO116372207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100329760HMedicaid
KSP00842622OtherRAILROAD MEDICARE
KS100329760IMedicaid
KS100329760FMedicaid
KSKA1021027OtherMEDICARE - CUSHING
MO203852801Medicaid
MOP00836140OtherRAILROAD MEDICARE
KS100329760AMedicaid
KS100329760FMedicaid
KS100329760AMedicaid
KS100329760HMedicaid
KS100329760IMedicaid
KSKA1021027OtherMEDICARE - CUSHING