Provider Demographics
NPI:1215972724
Name:REGEHR, RANDALL S (MD)
Entity type:Individual
Prefix:
First Name:RANDALL
Middle Name:S
Last Name:REGEHR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8035
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-0035
Mailing Address - Country:US
Mailing Address - Phone:316-689-9135
Mailing Address - Fax:316-689-9102
Practice Address - Street 1:1947 FOUNDERS ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3548
Practice Address - Country:US
Practice Address - Phone:316-689-9227
Practice Address - Fax:316-613-4735
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24305207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS12149394OtherMULTIPLAN
KS16946OtherCOVENTRY
KS4620OtherPHS
KS200345OtherHPK
KS041690OtherBCBS
KS4620OtherPHS
KS041690Medicare ID - Type Unspecified