=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578660585
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SABATO A SISILLO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 05/12/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16663 MIDLAND DR SUITE 100
-----------------------------------------------------
City | SHAWNEE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66217-3042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-268-5400
-----------------------------------------------------
Fax | 913-268-5410
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 25787
-----------------------------------------------------
City | SHAWNEE MISSION
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66225-5787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-268-5400
-----------------------------------------------------
Fax | 913-268-5410
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | 04-25382
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------