Healthcare Provider Details

I. General information

NPI: 1245404656
Provider Name (Legal Business Name): CASEY JASPER CORDTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N BROADWAY AVE
WICHITA KS
67214-2805
US

IV. Provider business mailing address

1150 N BROADWAY AVE
WICHITA KS
67214-2805
US

V. Phone/Fax

Practice location:
  • Phone: 316-866-2000
  • Fax:
Mailing address:
  • Phone: 316-866-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-35240
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: