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General NPI Number Information
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NPI Number | 1992897755
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Entity Type | Organization
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Legal Business Name | RAGHAVAN CLINIC, PA
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1035 N EMPORIA ST SUITE 245
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City | WICHITA
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State | KS
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Zip | 67214-2944
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Country | US
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Telephone | 316-262-7662
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Fax | 316-262-8320
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Provider Business Mailing Address
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Address Line | 1035 N EMPORIA ST SUITE 245
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City | WICHITA
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State | KS
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Zip | 67214-2944
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Country | US
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Telephone | 316-262-7662
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Fax | 316-262-8320
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. PRAKASH V RAGHAVAN
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Credential | MD
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Telephone | 316-262-7662
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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 | 04-18927
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License Number State | KS
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