Healthcare Provider Details

I. General information

NPI: 1821279399
Provider Name (Legal Business Name): PARAGYN SURGICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 08/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 N HILLSIDE ST STE 330
WICHITA KS
67214-4926
US

IV. Provider business mailing address

551 N HILLSIDE ST STE 330
WICHITA KS
67214-4926
US

V. Phone/Fax

Practice location:
  • Phone: 316-962-7188
  • Fax: 316-962-7199
Mailing address:
  • Phone: 316-962-7188
  • Fax: 316-962-7199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN E MILLER
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 316-962-7188