MEDICARE: DR. PHI VAN D.P.M.

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	213E00000X	Podiatrist	12-00347	KS

General Provider Information

NPI Number	:	1447202924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHI VAN D.P.M.

Provider Business Mailing Address
First Line	:	311 E SPRUCE ST
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-5614
Country	:	US
Telephone Number	:	620-275-3700
Fax Number	:	620-275-3717

Provider Business Practice Location Address
First Line	:	311 E SPRUCE ST
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-5614
Country	:	US
Telephone Number	:	620-275-3700
Fax Number	:	620-275-3717

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	02/13/2008

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