Unknown Individual – Family Medicine Physician, NPI 1063448678
Family Medicine Physician
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Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
4722, West Kellogg Drive, Wichita, Sedgwick County, Kansas, 67213, United States
WICHITA, KS 672092508
Phone: (316) 440-2565
Fax: (316) 440-2750
Type: Mailing
3701, East 13th Street North, Wichita, Sedgwick County, Kansas, 67208, United States
WICHITA, KS 672082086
Phone: (316) 866-2000
Fax: (316) 866-2084
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 67209)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | KS | |
| - | KS | |
| - | KS | |
| - | KS | |
| Internal Medicine | KS | |
| - | KS | |
| Nurse Practitioner | KS | |
| - | TX | |
| Internal Medicine | KS | |
| - | KS |
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