Healthcare Provider Details

I. General information

NPI: 1528424637
Provider Name (Legal Business Name): MICHAEL POPPA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2016
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 SQUIBB RD SUITE 105
MISSION KS
66202-3230
US

IV. Provider business mailing address

6700 SQUIBB RD SUITE 105
MISSION KS
66202-3230
US

V. Phone/Fax

Practice location:
  • Phone: 913-345-0550
  • Fax: 913-403-8955
Mailing address:
  • Phone: 913-345-0550
  • Fax: 913-403-8955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number18528
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: