Healthcare Provider Details

I. General information

NPI: 1285445155
Provider Name (Legal Business Name): JUSTIN CHIDI ARINZE ONWUGBUFOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W 8TH AVE
WINFIELD KS
67156-2718
US

IV. Provider business mailing address

11405 W MERRIDALE ST
WICHITA KS
67212-5660
US

V. Phone/Fax

Practice location:
  • Phone: 620-221-3350
  • Fax: 620-221-6061
Mailing address:
  • Phone: 316-706-6685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-03083
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: