Provider Demographics
NPI:1598725418
Name:ESTIVO, JOHN P (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:ESTIVO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6634 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3315
Mailing Address - Country:US
Mailing Address - Phone:316-946-0096
Mailing Address - Fax:316-946-9920
Practice Address - Street 1:6634 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3315
Practice Address - Country:US
Practice Address - Phone:316-946-0096
Practice Address - Fax:316-946-9920
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5-25156207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100235100CMedicaid
KS100235100CMedicaid