Healthcare Provider Details

I. General information

NPI: 1770805442
Provider Name (Legal Business Name): INFECTIOUS DISEASE CONSULTANTS P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S HILLSIDE ST
WICHITA KS
67211-2129
US

IV. Provider business mailing address

310 S HILLSIDE ST
WICHITA KS
67211-2129
US

V. Phone/Fax

Practice location:
  • Phone: 316-264-3505
  • Fax: 316-264-0908
Mailing address:
  • Phone: 316-264-3505
  • Fax: 316-264-0908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MARGARET HAGAN
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 316-264-3505