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General NPI Number Information
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NPI Number | 1063583862
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE ADULT MEDICINE, PA
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 05/13/2013
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Provider Practice Location Address
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Address Line | 1355 NORTH WEST STREET
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City | WICHITA
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State | KS
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Zip | 67203-1303
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Country | US
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Telephone | 316-942-0221
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Fax | 316-942-6012
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Provider Business Mailing Address
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Address Line | 1355 N WEST ST
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City | WICHITA
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State | KS
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Zip | 67203-1303
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Country | US
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Telephone | 316-942-0221
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Fax | 316-942-6012
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Authorized Official
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Title or Position | OWNER
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Name | DR. CARLENE DENISE KLASSEN
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Credential | MD
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Telephone | 316-942-0221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 04-24278
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License Number State | KS
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