MEDICARE: PAUL MICHAEL ELKIN DDS

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
1	1223P0221X	Pediatric Dentistry	50045841	NY
2	1223P0221X	Pediatric Dentistry	61114	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	003289976	OTHER	KS	UNITED CONCORDIA

General Provider Information

NPI Number	:	1568504017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL MICHAEL ELKIN DDS

Provider Business Mailing Address
First Line	:	650 N CARRIAGE PKWY
Second Line	:	#60
City	:	WICHITA
State	:	KS
Zip	:	67208-4507
Country	:	US
Telephone Number	:	316-686-2721
Fax Number	:	316-686-2744

Provider Business Practice Location Address
First Line	:	650 N CARRIAGE PKWY
Second Line	:	#60
City	:	WICHITA
State	:	KS
Zip	:	67208-4507
Country	:	US
Telephone Number	:	316-686-2721
Fax Number	:	316-686-2744

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	10/08/2015

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