Provider Demographics
NPI:1750490694
Name:MIJARES, REINALDO ERNESTO (MD)
Entity Type:Individual
Prefix:DR
First Name:REINALDO
Middle Name:ERNESTO
Last Name:MIJARES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7829 E ROCKHILL ST STE 307
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3914
Mailing Address - Country:US
Mailing Address - Phone:316-990-1295
Mailing Address - Fax:
Practice Address - Street 1:105 S BROADWAY ST
Practice Address - Street 2:SUITE 730
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-4227
Practice Address - Country:US
Practice Address - Phone:316-393-9933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0425360207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100169960BMedicaid
KS1750490694OtherBLUE CROSS
KSF91683Medicare UPIN
KS100169960BMedicaid