Michael S Fedotin, MD

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

R3526 Issued in MO

Practice address

2330 E Meyer Blvd
Suite 301
Kansas City, MO 64132-1132

Phone

(816) 333-5424

Fax

(816) 822-0870

NPI assigned

Jun 28, 2005

Last updated

Jan 25, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453680000000",
    "number": "1447256037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2330 E MEYER BLVD",
            "address_2": "SUITE 301",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641321132",
            "telephone_number": "816-333-5424",
            "fax_number": "816-822-0870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2330 E MEYER BLVD",
            "address_2": "SUITE 301",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641321132",
            "telephone_number": "816-333-5424",
            "fax_number": "816-822-0870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDOTIN",
        "first_name": "MICHAEL",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-28",
        "last_updated": "2016-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MO",
            "license": "R3526",
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "KS",
            "license": "14275",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "100003018",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200079309",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100005900A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William L Featherston, MD
• Theresa Ann Febbo, D.C.
• Daniel Richard Fecht, PHD
• Joel Maurice Feder, D.O.
• Marie Ellen Fedewa, D.O.
• Ann C Fee
• Alexandra Fees
• Rachel Feild, LCSW
• David A Feiock, MD
• Christine Feira, APRN

• Gastroenterology Physician in Kansas City, MO
• Providers in Kansas City, MO by specialty
• Gastroenterology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.