Provider Demographics
NPI:1043224603
Name:BLISS, KIRK R (DO)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:R
Last Name:BLISS
Suffix:
Gender:
Credentials:DO
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Mailing Address - Street 1:14700 W SAINT TERESA ST STE 300
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-9630
Mailing Address - Country:US
Mailing Address - Phone:316-274-0142
Mailing Address - Fax:316-721-8307
Practice Address - Street 1:14700 W SAINT TERESA ST STE 300
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-9630
Practice Address - Country:US
Practice Address - Phone:316-274-0142
Practice Address - Fax:316-721-8307
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS05-28918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS14296OtherPREFERRED HEALTH SYSTEMS
KS104651OtherBLUE CROSS BLUE SHIELD
KSP00220945OtherTRAVELERS MEDICARE
KSP00220945OtherTRAVELERS MEDICARE
KS104651Medicare ID - Type Unspecified