Provider Demographics
NPI:1861436347
Name:FELTS, THEODORE J (MD)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:J
Last Name:FELTS
Suffix:
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 1:7111 W 151ST ST
Mailing Address - Street 2:#41
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2231
Mailing Address - Country:US
Mailing Address - Phone:913-413-0016
Mailing Address - Fax:913-413-0017
Practice Address - Street 1:16139 FOSTER ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66085-8417
Practice Address - Country:US
Practice Address - Phone:913-413-0016
Practice Address - Fax:913-413-0017
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-26778207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100301780KMedicaid
KS100301780GMedicaid
MO1861436347Medicaid
KS100301780MMedicaid
P00338240OtherRAILROAD MEDICARE
MO22488110OtherBLUE SHIELD KC, MO
KSP03000004Medicare PIN
P00338240OtherRAILROAD MEDICARE
KS100301780MMedicaid
MO22488110OtherBLUE SHIELD KC, MO
KSKA1759001Medicare PIN