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NPI Code Detail

MEDICARE: MEDICAL ON DEMAND LLC

MEDICARE: MEDICAL ON DEMAND 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
1207Q00000XFamily 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 : 1518618958
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDICAL ON DEMAND LLC
Provider Business Mailing Address
First Line : 326 N WABASH AVE
Second Line :
City : WICHITA
State : KS
Zip : 67214-3948
Country : US
Telephone Number : 316-871-0995
Fax Number : 833-903-3589
Provider Business Practice Location Address
First Line : 10346 E STONEGATE LN STE 100
Second Line :
City : WICHITA
State : KS
Zip : 67206-2054
Country : US
Telephone Number : 316-871-0995
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. JUSTIN GOODEN
Credential : MD
Telephone Number : 316-871-0995
Provider Enumeration Date : 01/18/2022
Last Update Date : 03/18/2026

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Directions to “MEDICAL ON DEMAND LLC ” Practice Location

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