Individual
JEREMY LICKTEIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
750 W D AVE, KINGMAN, KS 67068-1266
(620) 532-3147
(855) 483-0002
Mailing address
750 W D AVE, KINGMAN, KS 67068-1266
(620) 532-3147
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
94-10493
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30004752260002
—
KS
Enumeration date
05/19/2021
Last updated
08/05/2025
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