Provider Demographics
NPI:1790011906
Name:CHARLES E. BARE II, M.D., P.A.
Entity Type:Organization
Organization Name:CHARLES E. BARE II, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:BARE
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:913-362-6781
Mailing Address - Street 1:PO BOX 2407
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66201-2407
Mailing Address - Country:US
Mailing Address - Phone:913-362-6781
Mailing Address - Fax:913-362-8646
Practice Address - Street 1:6909 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-1357
Practice Address - Country:US
Practice Address - Phone:913-362-6781
Practice Address - Fax:913-362-8646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0414404208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS620316OtherBLUE CROSS BLUE SHIELD
MO0003710BMedicare PIN
KSC51796Medicare UPIN
KS0003710AMedicare PIN