Healthcare Provider Details

I. General information

NPI: 1134131402
Provider Name (Legal Business Name): KENNETH ALLEN FISCHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 WESTPORT LANDING PL SUITE 101
MANHATTAN KS
66502-2906
US

IV. Provider business mailing address

1419 WESTPORT LANDING PL SUITE 101
MANHATTAN KS
66502-2906
US

V. Phone/Fax

Practice location:
  • Phone: 785-776-7500
  • Fax: 785-770-8558
Mailing address:
  • Phone: 785-776-7500
  • Fax: 785-770-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number04-28013
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number04-28013
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: