Provider Demographics
NPI:1588893697
Name:FENECH, MICHAEL SEAN (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SEAN
Last Name:FENECH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1 MT. CARMEL WAY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-3807
Mailing Address - Country:US
Mailing Address - Phone:620-230-0044
Mailing Address - Fax:620-230-0543
Practice Address - Street 1:1300 E CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-6650
Practice Address - Country:US
Practice Address - Phone:620-230-0044
Practice Address - Fax:620-230-0543
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2020-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0536103207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200493130AMedicaid
KS201074480AMedicaid
KS014041064Medicare PIN