Provider Demographics
NPI:1154854008
Name:KLECAN, KURTIS WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:KURTIS
Middle Name:WILLIAM
Last Name:KLECAN
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 1:257 N EDGEMOOR ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4420
Mailing Address - Country:US
Mailing Address - Phone:785-220-8570
Mailing Address - Fax:
Practice Address - Street 1:2337 G ST STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:KS
Practice Address - Zip Code:66935-2462
Practice Address - Country:US
Practice Address - Phone:785-527-2217
Practice Address - Fax:785-527-5929
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KS04-43665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program