Provider Demographics
NPI:1710953906
Name:WICHITA PEDIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:WICHITA PEDIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOPRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-685-5271
Mailing Address - Street 1:551 N HILLSIDE ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4923
Mailing Address - Country:US
Mailing Address - Phone:316-685-5271
Mailing Address - Fax:316-685-5275
Practice Address - Street 1:551 N HILLSIDE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4923
Practice Address - Country:US
Practice Address - Phone:316-685-5271
Practice Address - Fax:316-685-5275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0417764208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSE80797Medicare UPIN