Provider Demographics
NPI:1588869085
Name:WIPPERMAN, JENNIFER L (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:WIPPERMAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1010 N KANSAS ST
Mailing Address - Street 2:SUITE #3054
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3124
Mailing Address - Country:US
Mailing Address - Phone:316-293-2607
Mailing Address - Fax:316-293-1882
Practice Address - Street 1:1121 S CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2912
Practice Address - Country:US
Practice Address - Phone:316-689-5000
Practice Address - Fax:316-691-6719
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2010-12-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS046767207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200675920AMedicaid
KS110173189Medicare PIN