Provider Demographics
NPI:1588609051
Name:SPADE, DEE A (DO)
Entity Type:Individual
Prefix:
First Name:DEE
Middle Name:A
Last Name:SPADE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3243 E MURDOCK ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3052
Mailing Address - Country:US
Mailing Address - Phone:316-500-8900
Mailing Address - Fax:316-500-8950
Practice Address - Street 1:3243 E MURDOCK ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3052
Practice Address - Country:US
Practice Address - Phone:316-500-8900
Practice Address - Fax:316-500-8950
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS27612208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS054523OtherBCBS
KS100258OtherHPK
KS100324690AMedicaid
KS16995OtherCOVENTRY
KS11542OtherPHS
KS16995OtherCOVENTRY
KS11542OtherPHS