Provider Demographics
NPI:1104829803
Name:ROLES, BRITTANI JAJ (MD)
Entity type:Individual
Prefix:DR
First Name:BRITTANI
Middle Name:JAJ
Last Name:ROLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BRITTANI
Other - Middle Name:JAJ
Other - Last Name:ANTISDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1620 CHARLES PL
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2750
Mailing Address - Country:US
Mailing Address - Phone:785-776-1400
Mailing Address - Fax:785-776-7392
Practice Address - Street 1:1620 CHARLES PL
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2750
Practice Address - Country:US
Practice Address - Phone:785-776-1400
Practice Address - Fax:785-776-7392
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-28906207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100370560CMedicaid
KS100370560CMedicaid
KS100370560CMedicaid
H24328Medicare UPIN