Provider Demographics
NPI:1467436626
Name:CHATKUPT, SUTHON (MD)
Entity Type:Individual
Prefix:
First Name:SUTHON
Middle Name:
Last Name:CHATKUPT
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 1:1700 RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64024-1182
Mailing Address - Country:US
Mailing Address - Phone:816-629-2743
Mailing Address - Fax:816-629-2708
Practice Address - Street 1:1700 RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-1182
Practice Address - Country:US
Practice Address - Phone:816-629-2743
Practice Address - Fax:816-629-2708
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO33979208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
3127327007OtherCIGNA
4035241OtherAETNA
MO200236933Medicaid
1042753OtherECFMG
431726195OtherTAX ID
100240OtherFIRST GUARD
MO10270OtherBUNN
17080111OtherUNITED HEALTH CARE
36553OtherFIRST HEALTH
KS709912OtherBLUE CROSS BLUE SHIELD
021577062OtherRAILROAD MEDICARE
10001311700OtherCOMMUNITY HEALTH
301800OtherFAMILY HEALTH PARTNERS
00297056OtherBLUE CROSS BLUE SHIELD
33825OtherHEALTHCARE USA
33825OtherHEALTHCARE USA
36553OtherFIRST HEALTH
0003188AMedicare ID - Type Unspecified