Healthcare Provider Details

I. General information

NPI: 1932292547
Provider Name (Legal Business Name): RALPH BHARATI, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8911 E ORME SUITE A
WICHITA KS
67207
US

IV. Provider business mailing address

8911 E ORME SUITE A
WICHITA KS
67207
US

V. Phone/Fax

Practice location:
  • Phone: 316-686-7884
  • Fax: 316-686-0036
Mailing address:
  • Phone: 316-686-7884
  • Fax: 316-686-0036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1068
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0858
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1161
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number112
License Number StateKS
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number242
License Number StateKS
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0421258
License Number StateKS
# 8
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number74633
License Number StateKS
# 9
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number0421258
License Number StateKS

VIII. Authorized Official

Name: MR. GARY L JOHNSON
Title or Position: PRACTICE ADMINISTRATOR
Credential: CADC, RAODAC
Phone: 316-686-7884