MEDICARE: CHARLES E. BARE II, M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	0414404	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	620316	OTHER	KS	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1790011906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES E. BARE II, M.D., P.A.

Provider Business Mailing Address
First Line	:	PO BOX 2407
Second Line	:
City	:	MISSION
State	:	KS
Zip	:	66201-2407
Country	:	US
Telephone Number	:	913-362-6781
Fax Number	:	913-362-8646

Provider Business Practice Location Address
First Line	:	6909 SANTA FE DR
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66204-1357
Country	:	US
Telephone Number	:	913-362-6781
Fax Number	:	913-362-8646

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHARLES E BARE II
Credential	:	M.D.
Telephone Number	:	913-362-6781

Provider Enumeration Date	:	10/22/2009
Last Update Date	:	03/10/2010

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