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General NPI Number Information
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NPI Number | 1154708782
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Entity Type | Organization
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Legal Business Name | WICHITA ENDOCRINOLOGY, LLC
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Dates
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Enumeration Date | 05/04/2015
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Last Update Date | 05/04/2015
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Provider Practice Location Address
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Address Line | 1515 S CLIFTON AVE SUITE 103
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City | WICHITA
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State | KS
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Zip | 67218-2900
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Country | US
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Telephone | 316-777-6404
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Fax | 316-777-6600
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Provider Business Mailing Address
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Address Line | 1515 S CLIFTON AVE SUITE 103
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City | WICHITA
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State | KS
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Zip | 67218-2900
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Country | US
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Telephone | 316-777-6404
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Fax | 316-777-6600
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEE ANTOINETTE SPADE
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Credential | DO
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Telephone | 316-777-6404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 0527612
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License Number State | KS
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