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General NPI Number Information
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NPI Number | 1710219225
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Entity Type | Individual
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Provider Name | JESSE M. NIEDERKLEIN D.O.
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Gender | Male
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Dates
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Enumeration Date | 02/08/2010
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Last Update Date | 02/04/2016
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Provider Practice Location Address
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Address Line | 1 MT. CARMEL WAY
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City | PITSBURG
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State | KS
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Zip | 66762
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Country | US
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Telephone | 620-231-6100
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Fax | 620-231-0081
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Provider Business Mailing Address
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Address Line | 1 MT CARMEL WAY
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City | PITTSBURG
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State | KS
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Zip | 66762-7587
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Country | US
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Telephone | 620-231-7600
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Fax | 620-231-0081
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 4543
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 4543
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License Number State | KS
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