Healthcare Provider Details

I. General information

NPI: 1558938597
Provider Name (Legal Business Name): KYLE ELLINGSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N KANSAS ST
WICHITA KS
67214-3124
US

IV. Provider business mailing address

1 UNIVERSITY OF NEW MEXICO
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 316-293-2665
  • Fax:
Mailing address:
  • Phone: 505-272-2231
  • Fax: 505-272-8098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number94-10662
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: