MEDICARE: CHASE MICHAEL MCCOLLUM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1386432144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHASE MICHAEL MCCOLLUM

Provider Business Mailing Address
First Line	:	10022 W GREENSPOINT ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67205-1581
Country	:	US
Telephone Number	:	316-250-1573
Fax Number	:

Provider Business Practice Location Address
First Line	:	10022 W GREENSPOINT ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67205-1581
Country	:	US
Telephone Number	:	316-250-1573
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2025
Last Update Date	:	04/30/2025

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