Provider Demographics
NPI:1316233778
Name:DUKE, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DUKE
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 1:760 NW BLUE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:LEE'S SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5713
Mailing Address - Country:US
Mailing Address - Phone:913-297-7472
Mailing Address - Fax:816-347-2657
Practice Address - Street 1:760 NW BLUE PARKWAY
Practice Address - Street 2:
Practice Address - City:LEE'S SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5713
Practice Address - Country:US
Practice Address - Phone:913-297-7472
Practice Address - Fax:816-347-2657
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-44978207Q00000X
MO2011018181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine