Provider Demographics
NPI:1578660585
Name:SISILLO, SABATO A (MD)
Entity Type:Individual
Prefix:DR
First Name:SABATO
Middle Name:A
Last Name:SISILLO
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:PO BOX 25787
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66225-5787
Mailing Address - Country:US
Mailing Address - Phone:913-268-5400
Mailing Address - Fax:913-268-5410
Practice Address - Street 1:16663 MIDLAND DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-3042
Practice Address - Country:US
Practice Address - Phone:913-268-5400
Practice Address - Fax:913-268-5410
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-25382207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208041145Medicaid
22356075OtherBCBS KANSAS CITY
KS100179450CMedicaid
MO208041145Medicaid
P00004079Medicare ID - Type UnspecifiedRAILROAD MEDICARE
N978931Medicare ID - Type UnspecifiedWYANDOTTE/JOHNSON