Provider Demographics
NPI:1386641108
Name:DEWITT, DEANN E (MD)
Entity Type:Individual
Prefix:
First Name:DEANN
Middle Name:E
Last Name:DEWITT
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 1:1425 NW BLUE PKWY
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5705
Mailing Address - Country:US
Mailing Address - Phone:816-524-3223
Mailing Address - Fax:816-524-2076
Practice Address - Street 1:1425 NW BLUE PKWY
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5705
Practice Address - Country:US
Practice Address - Phone:816-524-3223
Practice Address - Fax:816-524-2076
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105919208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207985805Medicaid