MEDICARE: ANTOINETTE KITCH DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	036.161097	IL
2	207V00000X	Obstetrics & Gynecology Physician	14249440-1204	UT

General Provider Information

NPI Number	:	1033678800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINETTE KITCH DO

Provider Business Mailing Address
First Line	:	PO BOX 800022
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64180-0022
Country	:	US
Telephone Number	:	800-953-0104
Fax Number	:

Provider Business Practice Location Address
First Line	:	3336 S 4155 W
Second Line	:	STE 301
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120
Country	:	US
Telephone Number	:	801-964-3865
Fax Number	:	801-964-3894

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	01/30/2026

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