Provider Demographics
NPI:1720221617
Name:ANDERSON, KYLE A (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:A
Last Name:ANDERSON
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 1:2200 SW 6TH AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1707
Mailing Address - Country:US
Mailing Address - Phone:785-354-8518
Mailing Address - Fax:785-354-1255
Practice Address - Street 1:11301 NALL AVE STE 205
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1774
Practice Address - Country:US
Practice Address - Phone:913-451-5934
Practice Address - Fax:913-451-4716
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-36197207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201071670AMedicaid
KS110426026Medicare PIN