Provider Demographics
NPI:1528063583
Name:STREIT, JEROME G (MD)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:G
Last Name:STREIT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 659
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-0659
Mailing Address - Country:US
Mailing Address - Phone:316-268-8131
Mailing Address - Fax:316-291-4788
Practice Address - Street 1:1152 S CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2913
Practice Address - Country:US
Practice Address - Phone:316-689-5121
Practice Address - Fax:316-689-5122
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2010-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0417938207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSE96127Medicare UPIN