Provider Demographics
NPI:1851327043
Name:KASS, VELLO (MD)
Entity Type:Individual
Prefix:
First Name:VELLO
Middle Name:
Last Name:KASS
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:PO BOX 8035
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-0035
Mailing Address - Country:US
Mailing Address - Phone:316-689-9135
Mailing Address - Fax:316-689-9102
Practice Address - Street 1:720 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-8778
Practice Address - Country:US
Practice Address - Phone:316-284-5160
Practice Address - Fax:316-284-5115
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS25602207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100175470CMedicaid
KS5093OtherPHS
KS12149439OtherMULTIPLAN
KS201546OtherHPK
KS102033OtherBCBS
KS123898OtherCOVENTRY
KS12149439OtherMULTIPLAN
KS102033Medicare ID - Type Unspecified