Healthcare Provider Details

I. General information

NPI: 1972566073
Provider Name (Legal Business Name): RICHARD E LIEPINS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 N RIDGE RD
WICHITA KS
67212-1570
US

IV. Provider business mailing address

PO BOX 764
WICHITA KS
67201-0764
US

V. Phone/Fax

Practice location:
  • Phone: 316-721-1200
  • Fax: 316-721-8853
Mailing address:
  • Phone: 316-721-1200
  • Fax: 316-721-8853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05-31586
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: