Provider Demographics
NPI:1104813732
Name:TRENDLE, MICHAEL C (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:TRENDLE
Suffix:
Gender:M
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:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-8445
Practice Address - Fax:573-884-7822
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112173207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
110281OtherBCBS OF MO
MO208702308Medicaid
28104OtherGHP
5132415OtherAETNA
333188OtherHEALTHLINK
3600181OtherUNITED HEALTH CARE
F44709OtherMERCY HEALTH PLANS
MO208702308Medicaid
MOMA1231001Medicare PIN
MO127530001Medicare PIN
F44709OtherMERCY HEALTH PLANS
F44709Medicare UPIN