Provider Demographics
NPI:1730139437
Name:BETHEL, DONNA M (DO)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:M
Last Name:BETHEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:M
Other - Last Name:ST CLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2131 N RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-1570
Mailing Address - Country:US
Mailing Address - Phone:316-773-1212
Mailing Address - Fax:316-440-6601
Practice Address - Street 1:2131 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-1570
Practice Address - Country:US
Practice Address - Phone:316-773-1212
Practice Address - Fax:316-440-6601
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0524104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS105254OtherBCBS
KS100351540FMedicaid
KSE95632Medicare UPIN
KS105254Medicare ID - Type Unspecified