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General NPI Number Information
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NPI Number | 1912021551
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Entity Type | Organization
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Legal Business Name | WICHITA BONE & JOINT CENTER, PA
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 06/19/2009
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Provider Practice Location Address
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Address Line | 6634 W CENTRAL AVE SUITE 150
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City | WICHITA
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State | KS
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Zip | 67212-3315
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Country | US
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Telephone | 316-945-9915
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Fax | 316-612-1910
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Provider Business Mailing Address
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Address Line | PO BOX 780129
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City | WICHITA
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State | KS
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Zip | 67278-0129
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Country | US
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Telephone | 316-945-9915
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Fax | 316-612-1910
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL P. ESTIVO
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Credential | D.O.
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Telephone | 316-945-9915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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