Provider Demographics
NPI:1063724243
Name:BEVILLE, DENAE MARGUERITE (DO)
Entity type:Individual
Prefix:
First Name:DENAE
Middle Name:MARGUERITE
Last Name:BEVILLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DENAE
Other - Middle Name:MARGUERITE
Other - Last Name:TORPEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5500 E KELLOGG DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1607
Mailing Address - Country:US
Mailing Address - Phone:316-685-2221
Mailing Address - Fax:316-634-3058
Practice Address - Street 1:5500 E KELLOGG DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1607
Practice Address - Country:US
Practice Address - Phone:316-685-2221
Practice Address - Fax:316-634-3058
Is Sole Proprietor?:No
Enumeration Date:2010-07-05
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-37942207Q00000X
NE929207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201110660AMedicaid