Provider Demographics
NPI:1124096300
Name:KIBAR, NIZAR D (MD)
Entity type:Individual
Prefix:DR
First Name:NIZAR
Middle Name:D
Last Name:KIBAR
Suffix:
Gender:M
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:PO BOX 819
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-0819
Mailing Address - Country:US
Mailing Address - Phone:620-723-2127
Mailing Address - Fax:620-723-1037
Practice Address - Street 1:485 N KS HWY 2
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:KS
Practice Address - Zip Code:67003-2526
Practice Address - Country:US
Practice Address - Phone:206-914-1200
Practice Address - Fax:206-914-1252
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0429452207P00000X
KS04-29452207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100449120AMedicaid
KS110749009Medicare PIN
KSH77356Medicare UPIN