Provider Demographics
NPI:1336186196
Name:MACHEN, MICHAEL E (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:MACHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:QUINTER
Mailing Address - State:KS
Mailing Address - Zip Code:67752-9795
Mailing Address - Country:US
Mailing Address - Phone:785-754-3333
Mailing Address - Fax:785-754-2335
Practice Address - Street 1:501 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:QUINTER
Practice Address - State:KS
Practice Address - Zip Code:67752-9795
Practice Address - Country:US
Practice Address - Phone:785-754-3333
Practice Address - Fax:785-754-2335
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS21343207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS102119OtherBCBS
KS100203920AMedicaid
KS102119Medicare ID - Type Unspecified
KSD05315Medicare UPIN