Provider Demographics
NPI:1003853763
Name:DEW, MICHELLE L (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:DEW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9119 W 74TH ST STE 350
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2268
Mailing Address - Country:US
Mailing Address - Phone:913-632-9400
Mailing Address - Fax:913-632-9444
Practice Address - Street 1:9119 W 74TH ST STE 350
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66204-2268
Practice Address - Country:US
Practice Address - Phone:913-632-9400
Practice Address - Fax:913-632-9444
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-31781207RC0000X
MO2002002467207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200376630G - SLCCMedicaid
KSKA1021009OtherMEDICARE - CUSHING
KSP00842599OtherRAILROAD MEDICARE
KS200376630H - SLCCMedicaid
MO200547602Medicaid
KS200376630DMedicaid
MOP00836132OtherRAILROAD MEDICARE
KSP00842599OtherRAILROAD MEDICARE
I50550Medicare UPIN
MO200547602Medicaid
MOMA2491044Medicare PIN
MOMA2492044Medicare PIN