Provider Demographics
NPI:1003834276
Name:PEREIRA, WILLY G (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLY
Middle Name:G
Last Name:PEREIRA
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 1:6155 E HARRY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-3827
Mailing Address - Country:US
Mailing Address - Phone:316-682-1754
Mailing Address - Fax:
Practice Address - Street 1:6155 E HARRY ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-3827
Practice Address - Country:US
Practice Address - Phone:316-682-1754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0415565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS057396OtherBCBS
KSB68595Medicare UPIN
KS057396Medicare ID - Type Unspecified