Provider Demographics
NPI:1245313691
Name:DALENBERG, DALE D (MD)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:D
Last Name:DALENBERG
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 1:1301 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-3537
Mailing Address - Country:US
Mailing Address - Phone:758-229-8200
Mailing Address - Fax:
Practice Address - Street 1:1301 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3537
Practice Address - Country:US
Practice Address - Phone:785-229-8389
Practice Address - Fax:785-229-3335
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0422901207X00000X
MO2010006907207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100157550BMedicaid
MO23737030OtherBCBS KCMO CUSHING HOSPITAL PHYSICIAN SERVICES GROUP 43113013
MOMA2172001Medicare PIN
KSKA1021048Medicare PIN
MOMA2685001Medicare PIN
MO23737030OtherBCBS KCMO CUSHING HOSPITAL PHYSICIAN SERVICES GROUP 43113013