Provider Demographics
NPI:1831192921
Name:GARNER, MINDI SUZANNE (DO)
Entity type:Individual
Prefix:DR
First Name:MINDI
Middle Name:SUZANNE
Last Name:GARNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-3801
Mailing Address - Country:US
Mailing Address - Phone:620-232-7900
Mailing Address - Fax:620-232-7901
Practice Address - Street 1:127 W 5TH ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-3801
Practice Address - Country:US
Practice Address - Phone:620-232-7900
Practice Address - Fax:620-232-7901
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0529478207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSH53860Medicare UPIN
KS103260Medicare ID - Type Unspecified