Provider Demographics
NPI:1780678425
Name:CARABETTA, VITO JIMMY (MD)
Entity Type:Individual
Prefix:DR
First Name:VITO
Middle Name:JIMMY
Last Name:CARABETTA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:20670 WEST 151ST STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7239
Mailing Address - Country:US
Mailing Address - Phone:913-829-2525
Mailing Address - Fax:913-829-1748
Practice Address - Street 1:20670 WEST 151ST STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7239
Practice Address - Country:US
Practice Address - Phone:913-829-2525
Practice Address - Fax:913-829-1748
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2009-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS23314208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100104610DMedicaid
KS055847CAMedicare ID - Type Unspecified
A93476Medicare UPIN
KS100104610DMedicaid