Provider Demographics
NPI:1992209472
Name:RICKSTREW, JACE JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JACE
Middle Name:JAMES
Last Name:RICKSTREW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1861 N ROCK RD STE 310
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1264
Mailing Address - Country:US
Mailing Address - Phone:316-612-1833
Mailing Address - Fax:316-612-2420
Practice Address - Street 1:4201 ANDERSON AVE STE F
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-7603
Practice Address - Country:US
Practice Address - Phone:785-539-4645
Practice Address - Fax:785-539-1655
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS04-48669207ND0101X, 207N00000X
PAMD482559207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery