Provider Demographics
NPI:1891831343
Name:BLEIDISSEL, RONALD JOSEPH II
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:JOSEPH
Last Name:BLEIDISSEL
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6704 SW FINSBURY AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4452
Mailing Address - Country:US
Mailing Address - Phone:785-554-3060
Mailing Address - Fax:
Practice Address - Street 1:6704 SW FINSBURY AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-4452
Practice Address - Country:US
Practice Address - Phone:785-554-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator