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General NPI Number Information
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NPI Number | 1639143712
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF KANSAS SCHOOL OF MEDICINE WICHITA MEDICAL PRACTICE ASSOC
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Dates
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Enumeration Date | 02/15/2006
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Last Update Date | 04/04/2023
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Provider Practice Location Address
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Address Line | 1001 N MINNEAPOLIS
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City | WICHITA
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State | KS
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Zip | 67214-3199
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Country | US
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Telephone | 316-293-2620
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Fax | 316-293-1882
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Provider Business Mailing Address
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Address Line | 1010 N KANSAS STE 3049
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City | WICHITA
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State | KS
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Zip | 67214-3199
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Country | US
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Telephone | 316-293-2620
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Fax | 316-293-1882
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LEWIS AARON RYAN
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Credential | RN, MBA, FACMPE
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Telephone | 316-293-2620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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