Provider Demographics
NPI:1972603496
Name:CONSOLE, DAVID A (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:CONSOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2201 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66611-1908
Mailing Address - Country:US
Mailing Address - Phone:785-266-6162
Mailing Address - Fax:785-266-6546
Practice Address - Street 1:2201 SW 29TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-1908
Practice Address - Country:US
Practice Address - Phone:785-266-6162
Practice Address - Fax:785-266-6546
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2008-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-185802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00034222OtherRR MEDICARE
KS0000053342OtherBCBS
KS053342Medicare ID - Type Unspecified