Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 04-36531 | KS |
N | 208800000X | Urologist | MD192199 | OR |
NPI | 1043419872 |
---|---|
Provider Name | Nathaniel Kyle Ballek |
First Address | Lenexa, KS 66214-1656 |
Second Address | Overland Park, KS 66215-2307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 29/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
49160026 | BCBS (01) | KS |