=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063724243
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENAE MARGUERITE BEVILLE D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2010
-----------------------------------------------------
Last Update Date | 08/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5500 E KELLOGG DR
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67218-1607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-685-2221
-----------------------------------------------------
Fax | 316-634-3058
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5500 E KELLOGG DR
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67218-1607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-685-2221
-----------------------------------------------------
Fax | 316-634-3058
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 05-37942
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------