Provider Demographics
NPI:1669456901
Name:POPPE, MITCHELL VERN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:VERN
Last Name:POPPE
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:9415 E HARRY ST
Mailing Address - Street 2:STE 301
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-5089
Mailing Address - Country:US
Mailing Address - Phone:316-927-3884
Mailing Address - Fax:316-927-3886
Practice Address - Street 1:5401 COLLEGE BLVD
Practice Address - Street 2:STE 203
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1923
Practice Address - Country:US
Practice Address - Phone:913-553-4614
Practice Address - Fax:913-553-4615
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2011-09-23
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Provider Licenses
StateLicense IDTaxonomies
KS15-01245363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant