Provider Demographics
NPI:1386758910
Name:VEENIS, BLAKE C (MD)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:C
Last Name:VEENIS
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 1:3515 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-4921
Mailing Address - Country:US
Mailing Address - Phone:316-755-0144
Mailing Address - Fax:844-274-1204
Practice Address - Street 1:3515 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4921
Practice Address - Country:US
Practice Address - Phone:316-755-0144
Practice Address - Fax:844-274-1204
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-24463208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100145000BMedicaid
P00230276OtherRR MEDICARE
KSF58180Medicare UPIN