Provider Demographics
NPI:1730187402
Name:MCINTOSH, MICHELE C (MD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:C
Last Name:MCINTOSH
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 1:205 W R D MIZE RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2518
Mailing Address - Country:US
Mailing Address - Phone:816-655-0125
Mailing Address - Fax:816-228-1156
Practice Address - Street 1:205 W R D MIZE RD
Practice Address - Street 2:SUITE 304
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2518
Practice Address - Country:US
Practice Address - Phone:816-655-0125
Practice Address - Fax:816-228-1156
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7035208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1205144OtherUNITED HEALTH CARE
204100OtherFAMILY HEALTH PARTNERS
204101OtherFAMILY HEALTH PARTNERS
MO200044006Medicaid
4001736OtherAETNA
05427045OtherBLUE CROSS/BLUE SHIELD
312290OtherFIRST GUARD