Provider Demographics
NPI:1285852699
Name:RICHARD WHITLOW, M.D. PA
Entity Type:Organization
Organization Name:RICHARD WHITLOW, M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:WHITLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-772-8200
Mailing Address - Street 1:24028 131ST ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-7717
Mailing Address - Country:US
Mailing Address - Phone:913-351-4053
Mailing Address - Fax:
Practice Address - Street 1:1004 PROGRESS DR
Practice Address - Street 2:SUITE 220
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-6326
Practice Address - Country:US
Practice Address - Phone:913-772-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04 21644174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSCG8165OtherRAILROAD MEDICARE GROUP
KS110590OtherMEDICARE GROUP NUMBER
KSF26161Medicare UPIN
KS110590OtherMEDICARE GROUP NUMBER