Basic Information
| Provider Information | |||||||||
| NPI: | 1578672481 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | OPOLE | ||||||||
| FirstName: | ISAAC | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3901 RAINBOW BLVD., 4070 DELP, MS 4017 | ||||||||
| Address2: | KANSAS UNIVERSITY PHYSICIANS, INC. | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135882501 | ||||||||
| FaxNumber: | 9135883877 | ||||||||
| Practice Location | |||||||||
| Address1: | 3901 RAINBOW BLVD, 6040 DELP, MS 1020 | ||||||||
| Address2: | DIVISION OF GENERAL AND GERIATRIC MEDICINE, UNIVERSITY | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135886005 | ||||||||
| FaxNumber: | 9135883877 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 06/20/2014 | ||||||||
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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 | 207R00000X | 04-31556 | KS | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 04-31556 | KS | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 200353590A | 05 | KS | MEDICAID | 927877 | 01 | KS | FIRSTGUARD | OTHER | 208406306 | 05 | MO | MEDICAID | 35923028 | 01 | MO | BCBS KANSAS CITY | OTHER |