Provider Demographics
NPI:1366497885
Name:KRESIE, RANDALL J (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:J
Last Name:KRESIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6001 SW 6TH AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66615
Mailing Address - Country:US
Mailing Address - Phone:785-233-0011
Mailing Address - Fax:785-233-1292
Practice Address - Street 1:6001 SW 6TH AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66615
Practice Address - Country:US
Practice Address - Phone:785-233-0011
Practice Address - Fax:785-233-1292
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KSKS0421329207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSD17441Medicare UPIN
KS103175Medicare ID - Type Unspecified