Provider Demographics
NPI:1346296183
Name:FIELDS, ANDREW S (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:FIELDS
Suffix:
Gender:M
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:PO BOX 8035
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-0035
Mailing Address - Country:US
Mailing Address - Phone:316-689-9135
Mailing Address - Fax:316-689-9667
Practice Address - Street 1:13610 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-8776
Practice Address - Country:US
Practice Address - Phone:316-773-4500
Practice Address - Fax:316-689-9769
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-28418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100412640 AMedicaid
KS016581005Medicare PIN
101738Medicare PIN
H54431Medicare UPIN
016576003Medicare PIN