Provider Demographics
NPI:1639738644
Name:SAMPATH, ALEXIS RUFFOLO (MD)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:RUFFOLO
Last Name:SAMPATH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:MICHELLE
Other - Last Name:RUFFOLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4801 W 135TH ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66224-8901
Mailing Address - Country:US
Mailing Address - Phone:913-663-3838
Mailing Address - Fax:913-663-4434
Practice Address - Street 1:4801 W 135TH ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66224-8901
Practice Address - Country:US
Practice Address - Phone:913-663-3838
Practice Address - Fax:913-663-4434
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125074635208200000X
KS04-51286208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery