Provider Demographics
NPI:1417993676
Name:SABATES, ROLAND (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:
Last Name:SABATES
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 1:520 E 63RD ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-3330
Mailing Address - Country:US
Mailing Address - Phone:816-333-8600
Mailing Address - Fax:816-444-3304
Practice Address - Street 1:520 E 63RD ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-3330
Practice Address - Country:US
Practice Address - Phone:816-333-8600
Practice Address - Fax:816-444-3304
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO-R3C19207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201750437Medicaid
MO09720149OtherBCBS-CC LOCATION
MO09720119OtherBCBS
MO09720109OtherBCBS- SL LOCATION
KS100133460AMedicaid
MO180013444Medicare PIN
MO09720109OtherBCBS- SL LOCATION
MOB73761Medicare UPIN
KS100133460AMedicaid
MOM525017Medicare PIN
MOJ065017Medicare PIN
MOH495017Medicare PIN