Provider Demographics
NPI:1821232703
Name:BARTLOW, KELLIE R (DO)
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:R
Last Name:BARTLOW
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 1:1133 SW TOPEKA BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66629-0002
Mailing Address - Country:US
Mailing Address - Phone:785-291-8739
Mailing Address - Fax:
Practice Address - Street 1:1133 SW TOPEKA BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66629-0002
Practice Address - Country:US
Practice Address - Phone:785-291-8739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-37053207QS0010X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201098300AMedicaid
KS201098300AMedicaid