Provider Demographics
NPI:1407825599
Name:KODY, MICHAEL H (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:KODY
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 1:601 W 5TH AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2715
Mailing Address - Country:US
Mailing Address - Phone:509-344-2663
Mailing Address - Fax:509-624-9179
Practice Address - Street 1:601 W 5TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2715
Practice Address - Country:US
Practice Address - Phone:509-344-2663
Practice Address - Fax:509-624-9179
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028886174400000X
WA1068238207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA379109600OtherOWCP
MT0035776Medicaid
WA1408OtherGROUP HEALTH NW
WA8929876OtherCRIME VICTIMS
WA0149068OtherDEPT OF LABOR & INDUSTRIE
WA1068238Medicaid
WA200040944OtherRR MEDICARE
ID000010004256OtherREGENCE BLUE SHIELD OF ID
WA4588KOOtherASURIS NW HEALTH
ID44347OtherHMO BLUE
IDKQ506OtherBLUE CROSS OF IDAHO
ID003783300Medicaid
GAB21408Medicare PIN
WA0149068OtherDEPT OF LABOR & INDUSTRIE
MT0035776Medicaid
WAG319213900Medicare PIN