Provider Demographics
NPI:1699831206
Name:WHITTAKER, THOMAS J (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:WHITTAKER
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 411851
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1851
Mailing Address - Country:US
Mailing Address - Phone:913-588-6605
Mailing Address - Fax:913-588-0888
Practice Address - Street 1:7400 STATE LINE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3444
Practice Address - Country:US
Practice Address - Phone:913-588-6600
Practice Address - Fax:913-588-6655
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-26232207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100279310AMedicaid
180028802OtherRR MEDICARE
MO203229349Medicaid
MO20872138OtherBCBS KANSAS CITY
MO203229349Medicaid
3324781AMedicare ID - Type Unspecified