Provider Demographics
NPI:1467565879
Name:BACANI, OSWALDO CRUZ SR (MD)
Entity Type:Individual
Prefix:DR
First Name:OSWALDO
Middle Name:CRUZ
Last Name:BACANI
Suffix:SR
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:PO BOX 576
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:KS
Mailing Address - Zip Code:66736-0576
Mailing Address - Country:US
Mailing Address - Phone:620-378-3700
Mailing Address - Fax:620-378-3536
Practice Address - Street 1:1525 MADISON ST STE 3
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:KS
Practice Address - Zip Code:66736-1704
Practice Address - Country:US
Practice Address - Phone:620-378-3700
Practice Address - Fax:620-378-3536
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-17538207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0000002897OtherBLUE CROSS BLUE SHIELD
KS100087030-AMedicaid
KS0000002897OtherBLUE CROSS BLUE SHIELD
KS002897Medicare ID - Type Unspecified