Provider Demographics
NPI:1932187556
Name:KIFER, CHARLES J (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:KIFER
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 2467
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68848-2467
Mailing Address - Country:US
Mailing Address - Phone:308-865-2231
Mailing Address - Fax:308-338-1671
Practice Address - Street 1:18903 W 97TH TER
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66220-3360
Practice Address - Country:US
Practice Address - Phone:913-768-8292
Practice Address - Fax:913-768-8283
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE187142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00212767OtherRAILROAD MEDICARE
101418Medicare ID - Type Unspecified
P00212767OtherRAILROAD MEDICARE
E90270Medicare UPIN