Provider Demographics
NPI:1982686903
Name:CITA, KATHLEEN R (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:R
Last Name:CITA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5840 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-2128
Mailing Address - Country:US
Mailing Address - Phone:816-569-6989
Mailing Address - Fax:
Practice Address - Street 1:501 NW BARRY RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2732
Practice Address - Country:US
Practice Address - Phone:816-413-4543
Practice Address - Fax:816-413-2555
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006004614208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1481130Medicaid
MO200907707Medicaid
PA1481130Medicaid