Provider Demographics
NPI:1225078116
Name:SATTLER, JEFFREY W (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:W
Last Name:SATTLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:816-502-8752
Mailing Address - Fax:816-932-9670
Practice Address - Street 1:1500 STATE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067-1107
Practice Address - Country:US
Practice Address - Phone:660-259-2203
Practice Address - Fax:660-259-6819
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005039882207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO595956103Medicaid
MO010568509Medicaid
MO207541509OtherMEDICAID
36889011OtherBLUE CROSS BLUE SHIELD
MO595956202Medicaid
36889011OtherBCBS
MO540568508Medicaid
261320Medicare PIN
MO207541509OtherMEDICAID
36889011OtherBCBS
36889011OtherBLUE CROSS BLUE SHIELD
MO595956103Medicaid
P00393055Medicare PIN
P27E568Medicare PIN