Healthcare Provider Details

I. General information

NPI: 1447693445
Provider Name (Legal Business Name): BELINDA EDOKPOLO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E 23RD AVE
HUTCHINSON KS
67502
US

IV. Provider business mailing address

1701 E 23RD AVE
HUTCHINSON KS
67502-1105
US

V. Phone/Fax

Practice location:
  • Phone: 620-665-2000
  • Fax:
Mailing address:
  • Phone: 620-665-2000
  • Fax: 601-268-8399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0540324
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: