MEDICARE: ISAAC O OPOLE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	04-31556	KS
2	208M00000X	Hospitalist Physician	04-31556	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	927877	OTHER	KS	FIRSTGUARD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	35923028	OTHER	MO	BCBS KANSAS CITY

General Provider Information

NPI Number	:	1578672481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAAC O OPOLE M.D.

Provider Business Mailing Address
First Line	:	3901 RAINBOW BLVD., 4070 DELP, MS 4017
Second Line	:	KANSAS UNIVERSITY PHYSICIANS, INC.
City	:	KANSAS CITY
State	:	KS
Zip	:	66160
Country	:	US
Telephone Number	:	913-588-2501
Fax Number	:	913-588-3877

Provider Business Practice Location Address
First Line	:	3901 RAINBOW BLVD, 6040 DELP, MS 1020
Second Line	:	DIVISION OF GENERAL AND GERIATRIC MEDICINE, UNIVERSITY
City	:	KANSAS CITY
State	:	KS
Zip	:	66160
Country	:	US
Telephone Number	:	913-588-6005
Fax Number	:	913-588-3877

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	06/20/2014

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Directions to “ ISAAC O OPOLE M.D.” Practice Location

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