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General NPI Number Information
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NPI Number | 1861406175
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Entity Type | Organization
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Legal Business Name | GASTRO INTESTINAL CONSULTANTS OF MANHATTAN,P.A.
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 1213 HYLTON HEIGHTS RD SUITE 101
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City | MANHATTAN
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State | KS
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Zip | 66502-2810
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Country | US
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Telephone | 785-539-0156
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Fax | 785-539-0177
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Provider Business Mailing Address
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Address Line | 1213 HYLTON HEIGHTS RD SUITE 101
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City | MANHATTAN
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State | KS
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Zip | 66502-2810
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Country | US
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Telephone | 785-539-0156
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | W TRAVIS DIERENFELDT
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Credential | MD
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Telephone | 785-539-0156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 04-28673
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License Number State | KS
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