Provider Demographics
NPI:1720183742
Name:KAMINSKI, MAREK J (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MAREK
Middle Name:J
Last Name:KAMINSKI
Suffix:
Gender:M
Credentials:MD, PHD
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 1215
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67905-1215
Mailing Address - Country:US
Mailing Address - Phone:620-629-6638
Mailing Address - Fax:620-629-6684
Practice Address - Street 1:15 E 11TH ST
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2720
Practice Address - Country:US
Practice Address - Phone:620-624-9100
Practice Address - Fax:620-624-9107
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0974207N00000X
KS0427386207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS070015368OtherRAILROAD MEDICARE
KS100309860CMedicaid
KS060689OtherBLUE CROSS BLUE SHIELD
KS100309860CMedicaid