Healthcare Provider Details

I. General information

NPI: 1134449937
Provider Name (Legal Business Name): LILLIAN R HARSTINE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 N WEBB RD S 3
WICHITA KS
67226-8175
US

IV. Provider business mailing address

3223 N WEBB RD S 3
WICHITA KS
67226-8175
US

V. Phone/Fax

Practice location:
  • Phone: 316-609-3030
  • Fax: 316-609-3080
Mailing address:
  • Phone: 316-609-3030
  • Fax: 316-609-3080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number04-17007
License Number StateKS

VIII. Authorized Official

Name: LILLIAN R HARSTINE
Title or Position: PRESIDENT
Credential: MD
Phone: 316-609-3030