Provider Demographics
NPI:1134131402
Name:FISCHER, KENNETH ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALLEN
Last Name:FISCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1419 WESTPORT LANDING PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2906
Mailing Address - Country:US
Mailing Address - Phone:785-776-7500
Mailing Address - Fax:785-770-8558
Practice Address - Street 1:1419 WESTPORT LANDING PL
Practice Address - Street 2:SUITE 101
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2906
Practice Address - Country:US
Practice Address - Phone:785-776-7500
Practice Address - Fax:785-770-8558
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-28013208200000X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100396860AMedicaid
KSH43269Medicare UPIN
KS100396860AMedicaid