Healthcare Provider Details

I. General information

NPI: 1871519223
Provider Name (Legal Business Name): THEODORE L KITOWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 N 18TH ST
MARYSVILLE KS
66508-1338
US

IV. Provider business mailing address

708 N 18TH ST
MARYSVILLE KS
66508-1338
US

V. Phone/Fax

Practice location:
  • Phone: 785-562-2311
  • Fax: 785-562-2348
Mailing address:
  • Phone: 785-562-2311
  • Fax: 785-562-2348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number420460
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number420460
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: