Provider Demographics
NPI:1457765133
Name:KALLENBERGER, BENJAMIN SCOTT (DO)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:SCOTT
Last Name:KALLENBERGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 E 26TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-4314
Mailing Address - Country:US
Mailing Address - Phone:918-906-9110
Mailing Address - Fax:
Practice Address - Street 1:1010 N KANSAS ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3124
Practice Address - Country:US
Practice Address - Phone:316-293-2665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9408339207L00000X
OK6682207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology