Provider Demographics
NPI:1467453779
Name:MCNEIL, LARRY K (DPM)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:K
Last Name:MCNEIL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:400 N WOODLAWN ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4338
Mailing Address - Country:US
Mailing Address - Phone:316-685-3801
Mailing Address - Fax:316-685-6901
Practice Address - Street 1:400 N WOODLAWN ST
Practice Address - Street 2:SUITE 211
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4338
Practice Address - Country:US
Practice Address - Phone:316-685-3801
Practice Address - Fax:316-685-6901
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS213EG0000X213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0214580001Medicare NSC
KS006770Medicare PIN
KST43858Medicare UPIN