Provider Demographics
NPI:1740320829
Name:DIMITRI GOLFINOPOULOS, DO, PA
Entity type:Organization
Organization Name:DIMITRI GOLFINOPOULOS, DO, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIMITRI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLFINOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:913-681-2398
Mailing Address - Street 1:400 E RED BRIDGE RD STE 207
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4030
Mailing Address - Country:US
Mailing Address - Phone:913-681-2398
Mailing Address - Fax:913-681-2416
Practice Address - Street 1:400 E RED BRIDGE RD STE 207
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-4030
Practice Address - Country:US
Practice Address - Phone:913-681-2398
Practice Address - Fax:913-681-2416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-28058207R00000X
207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1558380576OtherUNICARE
MO248592636Medicaid
MOP00076982OtherMEDICARE RR
KS0005383087OtherAETNA
KSP928913AOtherMEDICARE
MOP928913OtherMEDICARE
KS1317379OtherUNITED HEALTH CARE
KY187170OtherCOVENTRY
KS200462170AMedicaid
MO200462170BOtherKMAP MO SIDE
KS686848OtherHEALTHLINK
KS7680021OtherCIGNA
KS22310017OtherBCBSKC
KSP920000AMedicare ID - Type Unspecified
DA8985Medicare ID - Type UnspecifiedRR MEDICARE
KS200462170AMedicaid