Provider Demographics
NPI:1407848450
Name:WICHITA ANESTHESIOLOGY CHARTERED
Entity Type:Organization
Organization Name:WICHITA ANESTHESIOLOGY CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-686-7327
Mailing Address - Street 1:8080 E CENTRAL AVE
Mailing Address - Street 2:STE 250
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2367
Mailing Address - Country:US
Mailing Address - Phone:316-686-7327
Mailing Address - Fax:316-686-1557
Practice Address - Street 1:8080 EAST CENTRAL
Practice Address - Street 2:SUITE 250
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2367
Practice Address - Country:US
Practice Address - Phone:316-686-7327
Practice Address - Fax:316-686-1557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100214420AMedicaid
KS16415OtherBC/BS
KS16415Medicare ID - Type Unspecified