Healthcare Provider Details

I. General information

NPI: 1891798005
Provider Name (Legal Business Name): CHRISTOPHER A MOELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 N WEBB RD
WICHITA KS
67206-3405
US

IV. Provider business mailing address

1911 N WEBB RD
WICHITA KS
67206-3405
US

V. Phone/Fax

Practice location:
  • Phone: 316-682-7546
  • Fax: 316-682-7561
Mailing address:
  • Phone: 316-682-7546
  • Fax: 316-682-7561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number04-21795
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: