Provider Demographics
NPI:1174559942
Name:DATTILIO, ROBERT E (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:DATTILIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2330 SHAWNEE MISSION PKWY
Mailing Address - Street 2:MEDICAL ADMINISTRATIVE SERVICES OF KU MED, STE. 312
Mailing Address - City:WESTWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2005
Mailing Address - Country:US
Mailing Address - Phone:913-588-9000
Mailing Address - Fax:913-588-9822
Practice Address - Street 1:6420 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64119
Practice Address - Country:US
Practice Address - Phone:913-945-9700
Practice Address - Fax:913-945-9707
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2018-06-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO107975207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080158296OtherRR MEDICARE
481159444OtherJAYHAWK TAX ID
157695XXOtherPREFERRED CARE OF NY
22039026OtherBCBS PICTURE HILLS UC
18960020OtherCFU BCBS
2057249OtherAETNA
21968021OtherBCBS PICTURE HILLS
10001644900OtherCHP CREEKWOOD
21968011OtherBCBS CREEKWOOD
21968021OtherBCBS PICTURE HILLS
MOJ617669Medicare PIN