Healthcare Provider Details

I. General information

NPI: 1154854008
Provider Name (Legal Business Name): KURTIS WILLIAM KLECAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2337 G ST STE 100
BELLEVILLE KS
66935-2462
US

IV. Provider business mailing address

257 N EDGEMOOR ST
WICHITA KS
67208-4420
US

V. Phone/Fax

Practice location:
  • Phone: 785-527-2217
  • Fax: 785-527-5929
Mailing address:
  • Phone: 785-220-8570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-43665
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: