MEDICARE: DR. DAMIEN L. RICKLIS M.D.

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	207R00000X	Internal Medicine Physician	A101322	CA

General Provider Information

NPI Number	:	1982866224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAMIEN L. RICKLIS M.D.

Provider Business Mailing Address
First Line	:	2000 OLATHE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-8505
Country	:	US
Telephone Number	:	913-588-1422
Fax Number	:	913-588-3877

Provider Business Practice Location Address
First Line	:	2000 OLATHE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-8505
Country	:	US
Telephone Number	:	913-588-1422
Fax Number	:	913-588-3877

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2008
Last Update Date	:	11/30/2022

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