Healthcare Provider Details

I. General information

NPI: 1528929536
Provider Name (Legal Business Name): BC COLLECTIVE OF KS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 E DOUGLAS AVE STE 150
WICHITA KS
67218-1011
US

IV. Provider business mailing address

133 NE 2ND AVE APT 1107
MIAMI FL
33132-2910
US

V. Phone/Fax

Practice location:
  • Phone: 302-463-1527
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. SABA HAQ
Title or Position: PRESIDENT
Credential: MD
Phone: 949-463-0650