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General NPI Number Information
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NPI Number | 1740420520
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Entity Type | Organization
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Legal Business Name | PREMIER PHLEBOLOGY, LLC
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Dates
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Enumeration Date | 03/06/2009
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Last Update Date | 03/06/2009
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Provider Practice Location Address
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Address Line | 2350 N GREENWICH RD
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City | WICHITA
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State | KS
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Zip | 67226-8269
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Country | US
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Telephone | 316-617-5891
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 47055
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City | WICHITA
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State | KS
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Zip | 67201-7055
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL CHEATUM
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Credential |
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Telephone | 316-617-5891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number |
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License Number State |
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