Provider Demographics
NPI:1811950777
Name:CAUGHRON, MICHAEL ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROBERT
Last Name:CAUGHRON
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 1:9600 E. 147TH STREET
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64149-1129
Mailing Address - Country:US
Mailing Address - Phone:816-763-5466
Mailing Address - Fax:949-270-7558
Practice Address - Street 1:9600 OUTER BELT RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64149-1129
Practice Address - Country:US
Practice Address - Phone:816-763-5466
Practice Address - Fax:949-270-7558
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7510207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS708813OtherKS BCBS
MO16002054OtherKANSAS CITY BCBS
MO202969523Medicaid
KS708813OtherKS BCBS
E37785Medicare UPIN