Provider Demographics
NPI:1679893788
Name:RUBENTHALER-BRUNKHARDT, KALI (DO)
Entity Type:Individual
Prefix:
First Name:KALI
Middle Name:
Last Name:RUBENTHALER-BRUNKHARDT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:GOODLAND
Mailing Address - State:KS
Mailing Address - Zip Code:67735-1518
Mailing Address - Country:US
Mailing Address - Phone:785-890-4012
Mailing Address - Fax:785-890-6077
Practice Address - Street 1:106 WILLOW RD
Practice Address - Street 2:
Practice Address - City:GOODLAND
Practice Address - State:KS
Practice Address - Zip Code:67735-1518
Practice Address - Country:US
Practice Address - Phone:785-890-4012
Practice Address - Fax:785-890-6077
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7419207Q00000X
KS0535360207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200750580CMedicaid
KS1679893788OtherBCBS
KS200750580CMedicaid