MEDICARE: DR. RICHARD HENRY EGELHOF M.D.

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	207Q00000X	Family Medicine Physician	0415947	KS

General Provider Information

NPI Number	:	1386647196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD HENRY EGELHOF M.D.

Provider Business Mailing Address
First Line	:	3730 N RIDGE RD
Second Line	:	STE 100
City	:	WICHITA
State	:	KS
Zip	:	67205-1228
Country	:	US
Telephone Number	:	316-462-6200
Fax Number	:	316-462-6214

Provider Business Practice Location Address
First Line	:	3730 N RIDGE RD
Second Line	:	STE 100
City	:	WICHITA
State	:	KS
Zip	:	67205-1228
Country	:	US
Telephone Number	:	316-462-6200
Fax Number	:	316-462-6214

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/09/2007

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