Provider Demographics
NPI:1194739821
Name:MANCINA, MICHAEL STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEVEN
Last Name:MANCINA
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 1:1610 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-2842
Mailing Address - Country:US
Mailing Address - Phone:913-888-8866
Mailing Address - Fax:913-888-8829
Practice Address - Street 1:1610 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-2842
Practice Address - Country:US
Practice Address - Phone:913-888-8866
Practice Address - Fax:913-888-8829
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-21587207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203275201Medicaid
KS100118280BMedicaid
KS100118280BMedicaid
A02469Medicare UPIN
KSC085905Medicare ID - Type UnspecifiedKANSAS CITY KS AREA
MO203275201Medicaid
MOC085905AMedicare ID - Type UnspecifiedKANSAS CITY MO AREA