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General NPI Number Information
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NPI Number | 1457314361
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Entity Type | Individual
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Provider Name | NIKOLOZ CHITAIA M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 19600 E 39TH ST S
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City | INDEPENDENCE
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State | MO
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Zip | 64057-2301
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Country | US
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Telephone | 913-222-9779
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Fax | 816-312-4380
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Provider Business Mailing Address
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Address Line | 19600 E 39TH ST S
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City | INDEPENDENCE
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State | MO
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Zip | 64057-2301
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Country | US
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Telephone | 913-222-9779
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Fax | 816-312-4380
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 2008031398
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License Number State | MO
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