Healthcare Provider Details

I. General information

NPI: 1598864001
Provider Name (Legal Business Name): PASTOR R CAUSIN JR. M.D., L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 N WEBB RD SUITE 5
WICHITA KS
67226-8175
US

IV. Provider business mailing address

5051 E LINCOLN ST 10-A
WICHITA KS
67218-2416
US

V. Phone/Fax

Practice location:
  • Phone: 316-609-3020
  • Fax: 316-609-3070
Mailing address:
  • Phone: 316-683-8849
  • Fax: 316-260-2611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number0429554
License Number StateKS

VIII. Authorized Official

Name: DR. PASTOR R CAUSIN JR.
Title or Position: DR.
Credential: M.D.
Phone: 316-609-3020