Individual
RICHARD M. DEITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3901 RAINBOW BLVD, PROFESSIONAL SERVICES OF KU HOSPITAL, KANSAS CITY, KS 66160-0001
(913) 588-6504
(913) 588-9104
Mailing address
2330 SHAWNEE MISSION PKWY, MEDICAL ADMINISTRATIVE SERVICES OF KU MED. STE 312, WESTWOOD, KS 66205-2005
(913) 588-9000
(913) 588-9822
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
04-25192
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10001571901
CHP PROVIDER NUMBER
—
01
—
2174725
AETNA
—
01
—
21890081
BCBS PSKU
—
01
—
625592
FIRSTGUARD
—
Enumeration date
08/30/2006
Last updated
11/14/2007
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