Provider Demographics
NPI:1295817492
Name:WITTEK, REAGAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:REAGAN
Middle Name:M
Last Name:WITTEK
Suffix:
Gender:F
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:PO BOX 26604
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64196-6604
Mailing Address - Country:US
Mailing Address - Phone:913-677-3113
Mailing Address - Fax:913-677-4514
Practice Address - Street 1:9119 W 74TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2236
Practice Address - Country:US
Practice Address - Phone:913-677-3113
Practice Address - Fax:913-677-4514
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-30641207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS33695015OtherBLUE CROSS BLUE SHIELD KC
KSD96D092Medicare ID - Type Unspecified
KS33695015OtherBLUE CROSS BLUE SHIELD KC