Basic Information
| Provider Information | |||||||||
| NPI: | 1902908148 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KREISLER | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2220 CANTERBURY DR | ||||||||
| Address2: | |||||||||
| City: | HAYS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 676012370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7856232254 | ||||||||
| FaxNumber: | 9135883365 | ||||||||
| Practice Location | |||||||||
| Address1: | 2220 CANTERBURY DR | ||||||||
| Address2: | |||||||||
| City: | HAYS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 676012370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7856232254 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2006 | ||||||||
| LastUpdateDate: | 05/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 04-29650 | KS | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 503940 | 01 | KS | FIRSTGUARD | OTHER | 205849607 | 05 | MO | MEDICAID | 31141013 | 01 | MO | BCBS KANSAS CITY | OTHER | 100419450A | 05 | KS | MEDICAID |