Provider Demographics
NPI:1336144203
Name:DORONIO, WENDELL PASTORFIDE (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:PASTORFIDE
Last Name:DORONIO
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 1:5800 FOXRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-2333
Mailing Address - Country:US
Mailing Address - Phone:913-261-3153
Mailing Address - Fax:913-262-3295
Practice Address - Street 1:20333 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5350
Practice Address - Country:US
Practice Address - Phone:913-791-4291
Practice Address - Fax:913-791-4291
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-208862085R0202X
MOR5E302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202154910Medicaid
KS100202390EMedicaid
KS100202390DMedicaid
KS100202390DMedicaid
MOJ96C252Medicare PIN
C5119Medicare UPIN
MO202154910Medicaid
KSJ96C252AMedicare PIN