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General NPI Number Information
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NPI Number | 1942182845
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Entity Type | Organization
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Legal Business Name | ENNOBLE HC KS II LLC
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 801 E DOUGLAS AVE FL 2ND
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City | WICHITA
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State | KS
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Zip | 67202-3515
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Country | US
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Telephone | 551-295-8223
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Fax |
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Provider Business Mailing Address
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Address Line | 2 UNIVERSITY PLZ STE 204
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City | HACKENSACK
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State | NJ
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Zip | 07601-6211
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Country | US
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Telephone | 551-295-8223
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MARK BRADSHAW
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Credential | MD
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Telephone | 551-295-8223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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