Provider Demographics
NPI:1871519223
Name:KITOWSKI, THEODORE L (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:L
Last Name:KITOWSKI
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 1:708 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66508-1338
Mailing Address - Country:US
Mailing Address - Phone:785-562-2311
Mailing Address - Fax:785-562-2348
Practice Address - Street 1:708 N 18TH ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66508-1338
Practice Address - Country:US
Practice Address - Phone:785-562-2311
Practice Address - Fax:785-562-2348
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4204602085R0202X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS047203OtherBC/BS
KS608180OtherFIRST GUARD
KS608180OtherFIRST GUARD
KS047203OtherBC/BS