Provider Demographics
NPI:1932223690
Name:PLATZ, KYLE EUGENE (DO)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:EUGENE
Last Name:PLATZ
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 1:1133 COLLEGE AVE BLDG A
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2770
Mailing Address - Country:US
Mailing Address - Phone:785-320-5000
Mailing Address - Fax:888-524-2251
Practice Address - Street 1:1133 COLLEGE AVE
Practice Address - Street 2:BLDG A, SUITE 211
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2770
Practice Address - Country:US
Practice Address - Phone:785-320-5000
Practice Address - Fax:888-524-2251
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0536797207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201093220AMedicaid
KSKA3054002Medicare PIN