MEDICARE: DR. CHRISTOPHER A MOELLER MD

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	207N00000X	Dermatology Physician	04-21795	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	101081	OTHER	KS	BCBS
2	637	OTHER	KS	PHS/PPK

General Provider Information

NPI Number	:	1891798005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER A MOELLER MD

Provider Business Mailing Address
First Line	:	1911 N WEBB RD
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-3405
Country	:	US
Telephone Number	:	316-682-7546
Fax Number	:	316-682-7561

Provider Business Practice Location Address
First Line	:	1911 N WEBB RD
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-3405
Country	:	US
Telephone Number	:	316-682-7546
Fax Number	:	316-682-7561

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2007

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