Provider Demographics
NPI:1245249044
Name:HETTINGER, CHRISTIAN A (MD)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:A
Last Name:HETTINGER
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 1:10701 NALL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1244
Mailing Address - Country:US
Mailing Address - Phone:913-338-5585
Mailing Address - Fax:913-338-3229
Practice Address - Street 1:10701 NALL AVE STE 100
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1244
Practice Address - Country:US
Practice Address - Phone:913-338-5585
Practice Address - Fax:913-338-3229
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010024966208800000X
KS04-34552208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
44580011OtherBCBS KC
P00893060OtherRR PIN
MOJ71A00008Medicare PIN
44580011OtherBCBS KC
P00893060OtherRR PIN