Healthcare Provider Details

I. General information

NPI: 1770080673
Provider Name (Legal Business Name): WICHITA DIABETES AND ENDOCRINOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8110 E 32ND ST N STE 125
WICHITA KS
67226-2644
US

IV. Provider business mailing address

8110 E 32ND ST N STE 125
WICHITA KS
67226-2623
US

V. Phone/Fax

Practice location:
  • Phone: 316-330-3636
  • Fax: 866-378-4552
Mailing address:
  • Phone: 316-330-3636
  • Fax: 844-322-8797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: AUBRY MAE BOYCE
Title or Position: CLINIC MANAGER
Credential:
Phone: 316-330-3636