Provider Demographics
NPI:1316956055
Name:LIND, EDWARD JOHN II (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOHN
Last Name:LIND
Suffix:II
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 1:1431 S BLUFFVIEW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218
Mailing Address - Country:US
Mailing Address - Phone:316-687-0776
Mailing Address - Fax:316-688-1512
Practice Address - Street 1:1431 S BLUFFVIEW
Practice Address - Street 2:SUITE 102
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218
Practice Address - Country:US
Practice Address - Phone:316-687-0776
Practice Address - Fax:316-688-1512
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-18244207Q00000X, 207QG0300X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS057455OtherBC/BS
KS080147935OtherMEDICARE RAILROAD
KS057455Medicare ID - Type Unspecified
KS057455OtherBC/BS