MEDICARE: CLOUD HEALTH MEDICAL GROUP OF KANSAS, P.A.

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1609559640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLOUD HEALTH MEDICAL GROUP OF KANSAS, P.A.

Provider Business Mailing Address
First Line	:	801 US HIGHWAY 1
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-3811
Country	:	US
Telephone Number	:	707-347-9651
Fax Number	:

Provider Business Practice Location Address
First Line	:	4601 E DOUGLAS AVE # 700
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67218-1011
Country	:	US
Telephone Number	:	707-347-9651
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	MARK WAYNE SHEN
Credential	:	M.D.
Telephone Number	:	707-347-9651

Provider Enumeration Date	:	08/08/2023
Last Update Date	:	10/08/2024

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