Provider Demographics
NPI:1770536880
Name:RATZLAFF, KEITH TODD (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:TODD
Last Name:RATZLAFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20375 W 151ST ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7218
Mailing Address - Country:US
Mailing Address - Phone:913-782-8487
Mailing Address - Fax:913-782-4634
Practice Address - Street 1:20375 W 151ST ST
Practice Address - Street 2:SUITE 105
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7218
Practice Address - Country:US
Practice Address - Phone:913-782-8487
Practice Address - Fax:913-782-4634
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0429864207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100428630CMedicaid
KS0333036DMedicare PIN
H72292Medicare UPIN