Provider Demographics
NPI:1619078797
Name:HERL, CARY JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:CARY
Middle Name:JOSEPH
Last Name:HERL
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 1:1133 COLLEGE AVE STE D200
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2776
Mailing Address - Country:US
Mailing Address - Phone:785-539-0800
Mailing Address - Fax:785-539-0811
Practice Address - Street 1:1133 COLLEGE AVE STE D200
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2776
Practice Address - Country:US
Practice Address - Phone:785-539-0800
Practice Address - Fax:785-539-0811
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0421450207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100162010DMedicaid
KS100162010DMedicaid
KS040000Medicare ID - Type Unspecified
KS4740190001Medicare NSC