Provider Demographics
NPI:1508870593
Name:TOTTA, CARRIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:A
Last Name:TOTTA
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 1:15009 DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2936
Mailing Address - Country:US
Mailing Address - Phone:913-402-4613
Mailing Address - Fax:
Practice Address - Street 1:8805 LONG ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-3585
Practice Address - Country:US
Practice Address - Phone:913-888-8866
Practice Address - Fax:913-888-8829
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-29777207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100393000BMedicaid
MO204699714Medicaid
G98962Medicare UPIN
KS103400Medicare ID - Type UnspecifiedKANSAS AREAS
KS100393000BMedicaid
MO204699714Medicaid
MOC08C786AMedicare ID - Type UnspecifiedKANSAS CITY AREA