Provider Demographics
NPI:1528263043
Name:DEUTSCH, JEREMY (MD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:DEUTSCH
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 1:818 N EMPORIA ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3729
Mailing Address - Country:US
Mailing Address - Phone:316-262-4467
Mailing Address - Fax:316-262-0706
Practice Address - Street 1:818 N EMPORIA ST
Practice Address - Street 2:SUITE 403
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3729
Practice Address - Country:US
Practice Address - Phone:316-262-4467
Practice Address - Fax:316-262-0706
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA39014207RH0003X
KS04-33369207RH0003X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200575450CMedicaid
04-33369OtherKANSAS LICENSE