Provider Demographics
NPI:1962478560
Name:CHYATTE, DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:CHYATTE
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 1:802 N RIVERSIDE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-2508
Mailing Address - Country:US
Mailing Address - Phone:816-271-4025
Mailing Address - Fax:816-271-4026
Practice Address - Street 1:802 N RIVERSIDE RD STE 120
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507
Practice Address - Country:US
Practice Address - Phone:816-271-4025
Practice Address - Fax:816-271-4026
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071584L207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001814695Medicaid
PA001814695Medicaid
E27743Medicare UPIN