MEDICARE: DR. MICHAEL D MORE DPM

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	213E00000X	Podiatrist	W59	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	311541	OTHER	WY	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760488407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL D MORE DPM

Provider Business Mailing Address
First Line	:	2029 BLUEGRASS CIR
Second Line	:	STE 200
City	:	CHEYENNE
State	:	WY
Zip	:	82009-7368
Country	:	US
Telephone Number	:	307-778-7666
Fax Number	:	307-632-4465

Provider Business Practice Location Address
First Line	:	2029 BLUEGRASS CIR
Second Line	:	STE 200
City	:	CHEYENNE
State	:	WY
Zip	:	82009-7368
Country	:	US
Telephone Number	:	307-778-7666
Fax Number	:	307-632-4465

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	10/22/2009

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