Healthcare Provider Details

I. General information

NPI: 1225324783
Provider Name (Legal Business Name): TEOLINDA MILSAP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 02/01/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N CARRIAGE PKWY
WICHITA KS
67208-4501
US

IV. Provider business mailing address

PO BOX 47490
WICHITA KS
67201-7490
US

V. Phone/Fax

Practice location:
  • Phone: 316-962-3100
  • Fax: 316-962-3132
Mailing address:
  • Phone: 316-962-3100
  • Fax: 316-962-3132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7692
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: