Healthcare Provider Details

I. General information

NPI: 1346294808
Provider Name (Legal Business Name): LYLE ZEPICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S HILLSIDE ST
WICHITA KS
67211-2157
US

IV. Provider business mailing address

PO BOX 47624
WICHITA KS
67201-7624
US

V. Phone/Fax

Practice location:
  • Phone: 316-616-2020
  • Fax: 316-616-2007
Mailing address:
  • Phone: 316-491-5926
  • Fax: 316-491-5962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0419176
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number19176
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: