Individual
MICHAEL S FEDOTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2330 E MEYER BLVD, SUITE 301, KANSAS CITY, MO 64132-1132
(816) 333-5424
(816) 822-0870
Mailing address
2330 E MEYER BLVD, SUITE 301, KANSAS CITY, MO 64132-1132
(816) 333-5424
(816) 822-0870
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
14275
KS
207RG0100X
Gastroenterology Physician
Primary
R3526
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100003018
RR MEDICARE
—
05
—
100005900A
—
KS
05
—
200079309
—
MO
Enumeration date
06/28/2005
Last updated
01/25/2016
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