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General NPI Number Information
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NPI Number | 1750752960
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Entity Type | Organization
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Legal Business Name | WICHITA FOOT AND ANKLE WOUND CENTER
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Dates
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Enumeration Date | 10/14/2015
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Last Update Date | 08/16/2016
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Provider Practice Location Address
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Address Line | 220 S HILLSIDE ST STE B
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City | WICHITA
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State | KS
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Zip | 67211-2151
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Country | US
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Telephone | 316-755-8004
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Fax | 316-652-9913
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Provider Business Mailing Address
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Address Line | 2522 N GRAYSTONE CIR
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City | WICHITA
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State | KS
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Zip | 67228-8039
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Country | US
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Telephone | 316-755-8004
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Fax | 316-652-9913
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER SURTMAN
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Credential | DPM
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Telephone | 316-755-8004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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