Healthcare Provider Details

I. General information

NPI: 1457764532
Provider Name (Legal Business Name): PAUL ALAN ENNS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9828 E SHANNON WOODS CIR STE 100
WICHITA KS
67226-4100
US

IV. Provider business mailing address

9828 E SHANNON WOODS CIR STE 100
WICHITA KS
67226-4100
US

V. Phone/Fax

Practice location:
  • Phone: 316-631-1600
  • Fax:
Mailing address:
  • Phone: 316-631-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number04-43321
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number04-43321
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: