Healthcare Provider Details

I. General information

NPI: 1417993304
Provider Name (Legal Business Name): WICHITA INFECTIOUS DISEASE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 08/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 N SAINT FRANCIS ST
WICHITA KS
67214-3821
US

IV. Provider business mailing address

155 N MARKET ST SUITE 950
WICHITA KS
67202-1816
US

V. Phone/Fax

Practice location:
  • Phone: 316-268-5050
  • Fax:
Mailing address:
  • Phone: 316-269-5000
  • Fax: 316-269-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGIA DENNE
Title or Position: MANAGER
Credential:
Phone: 316-269-5000