Provider Demographics
NPI:1609308824
Name:MISBIW
Entity Type:Organization
Organization Name:MISBIW
Other - Org Name:MEDICAL INNOVATIVE SOLUTIONS FOR BEAUTY, INTIMACY AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RHEA
Authorized Official - Middle Name:AVONNE
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-993-0972
Mailing Address - Street 1:8440 E 29TH ST N
Mailing Address - Street 2:SUITE 800
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-3406
Mailing Address - Country:US
Mailing Address - Phone:316-252-8533
Mailing Address - Fax:316-636-9542
Practice Address - Street 1:8440 E 29TH ST N
Practice Address - Street 2:SUITE 800
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-3406
Practice Address - Country:US
Practice Address - Phone:316-252-8533
Practice Address - Fax:316-636-9542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0428905207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty