Basic Information
| Provider Information | |||||||||
| NPI: | 1114205077 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ZHIDOVETSKIY | ||||||||
| FirstName: | DMITRIY | ||||||||
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| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3901 RAINBOW BLVD. 4070 DELP, MS 4017 | ||||||||
| Address2: | KANSAS UNIVERSITY PHYSICIANS, INC. | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 661600001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135882501 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3901 RAINBOW BLVD. 6040 DELP, MS 1020 | ||||||||
| Address2: | DIVISION OF GENERAL AND GERIATRIC MEDICINE, UNIVERSITY | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 661600001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135886005 | ||||||||
| FaxNumber: | 9135883877 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2011 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5315051258 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 05-37288 | KS | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.