Healthcare Provider Details

I. General information

NPI: 1992702328
Provider Name (Legal Business Name): PATTY L TENOFSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1947 N FOUNDERS CIR
WICHITA KS
67206-3548
US

IV. Provider business mailing address

PO BOX 8035
WICHITA KS
67208-0035
US

V. Phone/Fax

Practice location:
  • Phone: 316-613-4047
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0426594
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: