Provider Demographics
NPI:1548591126
Name:CHRISTOPHER H SURTMAN DPM LLC
Entity Type:Organization
Organization Name:CHRISTOPHER H SURTMAN DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SURTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:316-708-1317
Mailing Address - Street 1:2522 N GRAYSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67228-8039
Mailing Address - Country:US
Mailing Address - Phone:316-708-1317
Mailing Address - Fax:316-652-9913
Practice Address - Street 1:750 W D AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:KS
Practice Address - Zip Code:67068-1266
Practice Address - Country:US
Practice Address - Phone:316-708-1317
Practice Address - Fax:316-652-9913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00360213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty