Provider Demographics
NPI:1043419872
Name:BALLEK, NATHANIEL KYLE (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:KYLE
Last Name:BALLEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8551 BLUEJACKET ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1656
Mailing Address - Country:US
Mailing Address - Phone:913-981-1215
Mailing Address - Fax:913-439-4823
Practice Address - Street 1:10550 QUIVIRA RD STE 530
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66215-2307
Practice Address - Country:US
Practice Address - Phone:913-276-5130
Practice Address - Fax:913-439-4836
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD192199208800000X
KS04-36531208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS49160026OtherBCBS
MOJ71A00013Medicare PIN
49160016OtherBCBS KC