Basic Information
| Provider Information | |||||||||
| NPI: | 1487654695 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOODS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 PERSHING AVE | ||||||||
| Address2: | |||||||||
| City: | SHENANDOAH | ||||||||
| State: | IA | ||||||||
| PostalCode: | 516012355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122461230 | ||||||||
| FaxNumber: | 7122467357 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 PERSHING AVE | ||||||||
| Address2: | |||||||||
| City: | SHENANDOAH | ||||||||
| State: | IA | ||||||||
| PostalCode: | 516012355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122461230 | ||||||||
| FaxNumber: | 7122467357 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 10/25/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 27220 | IA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 17301 | NE | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VF0040X | 27220 | IA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2059832 | 05 | IA | MEDICAID | 160035546 | 01 | MEDICARE RR | OTHER | 91178487513 | 05 | NE | MEDICAID |