Provider Demographics
NPI: | 1932170537 |
---|---|
Name: | MCKITTRICK, RICHARD J (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | RICHARD |
Middle Name: | J |
Last Name: | MCKITTRICK |
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: | 11300 CORPORATE AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | LENEXA |
Mailing Address - State: | KS |
Mailing Address - Zip Code: | 66219-1374 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 913-574-2650 |
Mailing Address - Fax: | 913-574-2769 |
Practice Address - Street 1: | 12200 W 110TH ST |
Practice Address - Street 2: | |
Practice Address - City: | OVERLAND PARK |
Practice Address - State: | KS |
Practice Address - Zip Code: | 66210-4045 |
Practice Address - Country: | US |
Practice Address - Phone: | 913-574-2650 |
Practice Address - Fax: | 913-574-2769 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-01-31 |
Last Update Date: | 2023-08-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MO | 108885 | 207RH0003X |
KS | 0423158 | 207RH0003X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KS | 100126220C | Medicaid | |
MO | 1932170537 | Medicaid | |
KS | 100126220D | Medicaid | |
MO | 1932170537 | Medicaid | |
KS | 100126220C | Medicaid | |
KS | 100126220C | Medicaid |