Individual
MR. RUSSELL DAVID FIKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
18200 W 119TH ST, OLATHE, KS 66061-9507
(913) 355-8350
Mailing address
18200 W 119TH ST, OLATHE, KS 66061-9507
(913) 355-8350
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15-02556
KS
363A00000X
Physician Assistant
56568
CA
363AM0700X
Medical Physician Assistant
56568
CA
Other
Enumeration date
02/27/2019
Last updated
11/29/2021
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