MEDICARE: MOELLER DERMATOLOGY

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	174400000X	Specialist	04-21795	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417955717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOELLER DERMATOLOGY

Provider Business Mailing Address
First Line	:	1911 N WEBB RD
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-3405
Country	:	US
Telephone Number	:	316-682-7546
Fax Number	:	316-682-7554

Provider Business Practice Location Address
First Line	:	1911 N WEBB RD
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-3405
Country	:	US
Telephone Number	:	316-682-7546
Fax Number	:	316-682-7554

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. SARAH BIRD
Credential	:
Telephone Number	:	316-682-7546

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	06/23/2015

Similar Medicare Providers

1760353197 — FOREFRONT DERMATOLOGY - KANSAS, PA
Practice Location Address:

1911 N WEBB RD
WICHITA, KS
67206-3405

Practice Phone: 316-682-7546
Practice Fax: 316-682-7554

1891798005 — DR. CHRISTOPHER A MOELLER MD
Practice Location Address:

1911 N WEBB RD
WICHITA, KS
67206-3405

Practice Phone: 316-682-7546
Practice Fax: 316-682-7561

1134124084 — RUTH E BUSCH ARNP
Practice Location Address:

1921 N WEBB RD
WICHITA, KS
67206-3405

Practice Phone: 316-612-6815
Practice Fax: 316-612-4825

1336145804 — DR. TIMOTHY S SHAVER MD
Practice Location Address:

1921 N WEBB RD
WICHITA, KS
67206-3405

Practice Phone: 316-612-4815
Practice Fax: 316-612-4825

1811998792 — MRS. KAREN L BOHATY PA-C
Practice Location Address:

1911 N WEBB RD
WICHITA, KS
67206-3405

Practice Phone: 316-682-7546
Practice Fax: 316-682-7554

1568457950 — SHADI HASSAN SHAHOURI MD
Practice Location Address:

1921 N WEBB RD
WICHITA, KS
67206-3405

Practice Phone: 316-612-4815
Practice Fax: 316-681-0244

Directions to “MOELLER DERMATOLOGY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.