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NPI Code Detail

MEDICARE: MEDICINE AND NEPHROLOGY CLINIC LLC

MEDICARE: MEDICINE AND NEPHROLOGY CLINIC LLC
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
1207RN0300XNephrology Physician
2207R00000XInternal Medicine Physician

Other Identifiers

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

General Provider Information

NPI Number : 1427509751
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDICINE AND NEPHROLOGY CLINIC LLC
Provider Business Mailing Address
First Line : 700 W CENTRAL AVE STE 206
Second Line :
City : EL DORADO
State : KS
Zip : 67042-2186
Country : US
Telephone Number : 316-452-5455
Fax Number : 316-321-0503
Provider Business Practice Location Address
First Line : 700 W CENTRAL AVE STE 206
Second Line :
City : EL DORADO
State : KS
Zip : 67042-2186
Country : US
Telephone Number : 316-452-5455
Fax Number : 316-321-0503
Authorized Official
Title or Position : OWNER
Name : DR. NDUBUEZE FIDELIS OKONKWO
Credential : M.D
Telephone Number : 316-452-5455
Provider Enumeration Date : 10/21/2016
Last Update Date : 11/01/2016

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Directions to “MEDICINE AND NEPHROLOGY CLINIC LLC ” Practice Location

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