Provider Demographics
NPI:1790780831
Name:CHALLANS, PHILLIP D (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:D
Last Name:CHALLANS
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 1:2600 N WOODLAWN BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-2729
Mailing Address - Country:US
Mailing Address - Phone:316-684-3838
Mailing Address - Fax:316-858-2530
Practice Address - Street 1:2535 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-3821
Practice Address - Country:US
Practice Address - Phone:316-687-9794
Practice Address - Fax:316-689-6957
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-30233207RE0101X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSI12763Medicare UPIN
KS10591Medicare PIN
KS004052047Medicare PIN
KSCU0422OtherMEDICARE RAILROAD GROUP
KS10591Medicare PIN
KSA018OtherTRICARE/TRIWEST
KS004052047Medicare PIN
KS0000105901OtherBCBS
KS2246681OtherFIRST HEALTH
KS200270040EMedicaid
KS200270040AMedicaid