Provider Demographics
NPI:1043286420
Name:BLIESE, KATHLEEN ANDERSON (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ANDERSON
Last Name:BLIESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720N WEBB RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-3310
Mailing Address - Country:US
Mailing Address - Phone:308-384-2282
Mailing Address - Fax:308-384-2565
Practice Address - Street 1:405 W PEARL ST
Practice Address - Street 2:BOX 458
Practice Address - City:ATKINSON
Practice Address - State:NE
Practice Address - Zip Code:68713-0458
Practice Address - Country:US
Practice Address - Phone:402-925-2631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE278395Medicare ID - Type Unspecified
B90931Medicare UPIN