Provider Demographics
NPI:1760478713
Name:POGGI, JOSEPH T (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:T
Last Name:POGGI
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 1:3510 N. RIDGE ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1210
Mailing Address - Country:US
Mailing Address - Phone:316-269-3223
Mailing Address - Fax:316-269-3328
Practice Address - Street 1:3510 N. RIDGE ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1210
Practice Address - Country:US
Practice Address - Phone:316-269-3223
Practice Address - Fax:316-269-3328
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-295912086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100422880AMedicaid
KS100422880AMedicaid
KSH62362Medicare UPIN
KS100422880AMedicaid