Provider Demographics
NPI:1043266091
Name:DUDZINSKI, MICHELLE R (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:DUDZINSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9301 W 74TH ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2207
Mailing Address - Country:US
Mailing Address - Phone:913-632-9130
Mailing Address - Fax:913-632-9149
Practice Address - Street 1:9301 W 74TH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2207
Practice Address - Country:US
Practice Address - Phone:913-632-9130
Practice Address - Fax:913-632-9149
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS427545207VX0201X
MO100151207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
160056241OtherRAILROAD MEDICARE
MO203448204Medicaid
33677OtherHEALTHCARE USA
4408217OtherAETNA
18093039OtherBCBS OF KANSAS CITY
7400201OtherUHC
MOB69991Medicare UPIN
MOW19000152Medicare PIN
33677OtherHEALTHCARE USA
MOL761779Medicare PIN