Provider Demographics
NPI:1154371722
Name:CHRISTIAN-RITTER, KARLYLE K (MD)
Entity type:Individual
Prefix:
First Name:KARLYLE
Middle Name:K
Last Name:CHRISTIAN-RITTER
Suffix:
Gender:F
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:PO BOX 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-5583
Mailing Address - Fax:573-331-5079
Practice Address - Street 1:211 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5049
Practice Address - Country:US
Practice Address - Phone:573-331-5504
Practice Address - Fax:573-331-5086
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100798208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150425001Medicaid
MO207806019Medicaid
KY64070568Medicaid
260401OtherHEALTHLINK
270020185OtherRAILROAD MEDICARE
MO446151OtherBCBS
011013247Medicare PIN
MO207806019Medicaid