MEDICARE: BRENDA A ISSA M.D.

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	208000000X	Pediatrics Physician	04-29264	KS

General Provider Information

NPI Number	:	1770557894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA A ISSA M.D.

Provider Business Mailing Address
First Line	:	1010 N KANSAS ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67214-3124
Country	:	US
Telephone Number	:	316-293-2631
Fax Number	:	316-293-2689

Provider Business Practice Location Address
First Line	:	1010 N KANSAS ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67214-3124
Country	:	US
Telephone Number	:	316-293-2631
Fax Number	:	316-293-2689

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	11/11/2008

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