Individual
THOMAS J WHITTAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7400 STATE LINE RD, SUITE 100, PRAIRIE VILLAGE, KS 66208-3444
(913) 588-6600
(913) 588-6655
Mailing address
PO BOX 411851, KANSAS CITY, MO 64141-1851
(913) 588-6605
(913) 588-0888
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
04-26232
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100279310A
—
KS
01
—
180028802
RR MEDICARE
—
05
—
203229349
—
MO
01
—
20872138
BCBS KANSAS CITY
MO
Enumeration date
12/28/2006
Last updated
07/15/2014
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