Provider Demographics
NPI:1285792218
Name:OHAEBOSIM, LINUS C (DO)
Entity type:Individual
Prefix:DR
First Name:LINUS
Middle Name:C
Last Name:OHAEBOSIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-2252
Mailing Address - Country:US
Mailing Address - Phone:316-681-1901
Mailing Address - Fax:316-618-7362
Practice Address - Street 1:2810 E 21ST ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-2252
Practice Address - Country:US
Practice Address - Phone:316-681-1901
Practice Address - Fax:316-681-1901
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-16911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4083832OtherAETNA
KS693OtherPHS
KS100098690AMedicaid
KS49202OtherBLUE SHIELD
614790OtherFIRST GUARD
KS49202OtherBLUE SHIELD
4083832OtherAETNA