Provider Demographics
NPI:1154708782
Name:WICHITA ENDOCRINOLOGY, LLC
Entity type:Organization
Organization Name:WICHITA ENDOCRINOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEE
Authorized Official - Middle Name:ANTOINETTE
Authorized Official - Last Name:SPADE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:316-777-6404
Mailing Address - Street 1:1515 S CLIFTON AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2900
Mailing Address - Country:US
Mailing Address - Phone:316-777-6404
Mailing Address - Fax:316-777-6600
Practice Address - Street 1:1515 S CLIFTON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2900
Practice Address - Country:US
Practice Address - Phone:316-777-6404
Practice Address - Fax:316-777-6600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0527612261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center