Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 0429452 | KS |
Y | 207RG0300X | Geriatric Medicine | 04-29452 | KS |
NPI | 1124096300 |
---|---|
Provider Name | Dr. Nizar D Kibar |
First Address | Wichita, KS 67201-0819 |
Second Address | Anthony, KS 67003-2526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 06/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100449120A | (05) | KS |
H77356 | (02) | KS |