Provider Demographics
NPI:1467866178
Name:ORNELAS, SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:ORNELAS
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 1:1133 COLLEGE AVE STE C143
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2751
Mailing Address - Country:US
Mailing Address - Phone:785-539-7641
Mailing Address - Fax:785-537-7620
Practice Address - Street 1:1133 COLLEGE AVE STE C143
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2751
Practice Address - Country:US
Practice Address - Phone:785-539-7641
Practice Address - Fax:785-537-7620
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9408359207R00000X
TXR68622085R0202X
KS04382672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine