Healthcare Provider Details

I. General information

NPI: 1720523251
Provider Name (Legal Business Name): KANSAS PLASTIC SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10111 E 21ST ST N STE 305
WICHITA KS
67206-3581
US

IV. Provider business mailing address

10111 E 21ST ST N STE 305
WICHITA KS
67206-3581
US

V. Phone/Fax

Practice location:
  • Phone: 316-305-9618
  • Fax: 316-440-9701
Mailing address:
  • Phone: 316-305-9618
  • Fax: 316-440-9701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number04-27772
License Number StateKS

VIII. Authorized Official

Name: DR. KENTON W SCHOONOVER
Title or Position: OWNER
Credential: MD
Phone: 316-305-9618