Provider Demographics
NPI:1740415785
Name:KITANO, MIO (MD)
Entity Type:Individual
Prefix:DR
First Name:MIO
Middle Name:
Last Name:KITANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-450-5990
Mailing Address - Fax:
Practice Address - Street 1:7979 WURZBACH RD
Practice Address - Street 2:6TH FLOOR, ZELLER BLDG
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4427
Practice Address - Country:US
Practice Address - Phone:210-450-5990
Practice Address - Fax:210-450-1747
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51796020208600000X
TXQ96552086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX363450301Medicaid
TX363450302OtherCSHCN
TX363450301Medicaid