Provider Demographics
NPI:1326075037
Name:DUNIVEN, PHILIP LOREN (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:LOREN
Last Name:DUNIVEN
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:TOPEKA VA MEDICAL CTR
Mailing Address - Street 2:2200 GAGE BLVD.
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66622-0001
Mailing Address - Country:US
Mailing Address - Phone:785-350-3111
Mailing Address - Fax:
Practice Address - Street 1:TOPEKA VA MEDICAL CTR
Practice Address - Street 2:2200 GAGE BLVD.
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66622-0001
Practice Address - Country:US
Practice Address - Phone:785-350-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-193302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS052496OtherBC/BS PREMIER BLUE
KS100129540CMedicaid
KS052496OtherBC/BS PREMIER BLUE