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General NPI Number Information
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NPI Number | 1528063583
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Entity Type | Individual
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Provider Name | JEROME G STREIT MD
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Gender | Male
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 1152 S CLIFTON AVE
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City | WICHITA
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State | KS
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Zip | 67218-2913
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Country | US
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Telephone | 316-689-5121
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Fax | 316-689-5122
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Provider Business Mailing Address
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Address Line | PO BOX 659
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City | WICHITA
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State | KS
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Zip | 67201-0659
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Country | US
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Telephone | 316-268-8131
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Fax | 316-291-4788
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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 | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 0417938
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License Number State | KS
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