Basic Information
Provider Information
NPI: 1124414065
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PIERPOLINE
FirstName: MICHAEL
MiddleName: JOSEPH
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4000 CAMBRIDGE ST STE G600
Address2:  
City: KANSAS CITY
State: KS
PostalCode: 661608501
CountryCode: US
TelephoneNumber: 9135889600
FaxNumber:  
Practice Location
Address1: 4000 CAMBRIDGE ST STE G600
Address2:  
City: KANSAS CITY
State: KS
PostalCode: 661608501
CountryCode: US
TelephoneNumber: 9135889600
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/07/2015
LastUpdateDate: 08/12/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/12/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207RC0000X05-41410KSY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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