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NPI Code Detail

MEDICARE: ROSALIE R FOCKEN MD

MEDICARE: ROSALIE R FOCKEN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician25432KS

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1059201OTHERMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205862356
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROSALIE R FOCKEN MD
Provider Business Mailing Address
First Line : PO BOX 8035
Second Line :
City : WICHITA
State : KS
Zip : 67208-0035
Country : US
Telephone Number : 316-689-9135
Fax Number : 316-689-9102
Provider Business Practice Location Address
First Line : 14700 W SAINT TERESA ST STE 300
Second Line :
City : WICHITA
State : KS
Zip : 67235-9630
Country : US
Telephone Number : 316-274-0142
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2006
Last Update Date : 11/08/2018

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