Provider Demographics
NPI:1588634224
Name:BUKATY, JOHN ANDREW (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANDREW
Last Name:BUKATY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4925 JUNIPER DR
Mailing Address - Street 2:
Mailing Address - City:ROELAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66205-1253
Mailing Address - Country:US
Mailing Address - Phone:913-362-4825
Mailing Address - Fax:
Practice Address - Street 1:4925 JUNIPER DR
Practice Address - Street 2:
Practice Address - City:ROELAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66205-1253
Practice Address - Country:US
Practice Address - Phone:913-362-4825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS31267207Q00000X
MO2004012747207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200355030FMedicaid
MOGROUP P530000OtherRR MEDICARE
MOINDIVIDUAL P5300002OtherRR MEDICARE
MOP00607207OtherRAILROAD MEDICARE
MO1588634224Medicaid
MOGRP P530000Medicare PIN
MOP5800002Medicare PIN
MOINDIVIDUAL P5300002Medicare PIN
I41414Medicare UPIN
MOP00607207Medicare PIN