Provider Demographics
NPI:1588152607
Name:BROCKMAN, MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:
Last Name:BROCKMAN
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 1:345 N RIVERVIEW ST STE 500
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-4265
Mailing Address - Country:US
Mailing Address - Phone:316-616-1055
Mailing Address - Fax:855-633-0585
Practice Address - Street 1:345 N RIVERVIEW ST STE 500
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4265
Practice Address - Country:US
Practice Address - Phone:316-616-1055
Practice Address - Fax:855-633-0585
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-46674207R00000X
MO2021026162207RH0002X
OK40229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty