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General NPI Number Information
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NPI Number | 1124511399
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Entity Type | Individual
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Provider Name | ANDREW DECLERK MD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 9350 E 35TH ST N STE 103
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City | WICHITA
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State | KS
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Zip | 67226-2022
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Country | US
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Telephone | 316-263-0296
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Fax |
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Provider Business Mailing Address
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Address Line | 551 N HILLSIDE ST STE 201
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City | WICHITA
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State | KS
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Zip | 67214-4925
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Country | US
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Telephone | 316-263-0296
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 04-50892
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 04-50892
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License Number State | KS
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