Provider Demographics
NPI:1871572792
Name:SITZMAN, EVERETTE THEODORE JR (MD)
Entity type:Individual
Prefix:
First Name:EVERETTE
Middle Name:THEODORE
Last Name:SITZMAN
Suffix:JR
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 1:5200 W 94TH TER
Mailing Address - Street 2:STE 105
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66207-2522
Mailing Address - Country:US
Mailing Address - Phone:913-649-5567
Mailing Address - Fax:913-649-7563
Practice Address - Street 1:5200 W 94TH TER
Practice Address - Street 2:STE 105
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66207-2522
Practice Address - Country:US
Practice Address - Phone:913-649-5567
Practice Address - Fax:913-649-7563
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04 220792084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
15094011OtherBC BS OF KC
E30221Medicare UPIN