Provider Demographics
NPI:1083672141
Name:WERTZBERGER, KENNETH L (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:L
Last Name:WERTZBERGER
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 1:907 ARKANSAS
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-3947
Mailing Address - Country:US
Mailing Address - Phone:785-842-0611
Mailing Address - Fax:785-842-7488
Practice Address - Street 1:907 ARKANSAS
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-3947
Practice Address - Country:US
Practice Address - Phone:785-842-0611
Practice Address - Fax:785-842-7488
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0416556207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100197290AMedicaid
KSKA2497001Medicare Oscar/Certification
KS100197290AMedicaid