Provider Demographics
NPI:1922109164
Name:FORGE, JOHN K (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:K
Last Name:FORGE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1010 N KANSAS ST
Mailing Address - Street 2:SUITE #3054
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3124
Mailing Address - Country:US
Mailing Address - Phone:316-293-3429
Mailing Address - Fax:316-293-1882
Practice Address - Street 1:1125 N TOPEKA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-2809
Practice Address - Country:US
Practice Address - Phone:316-293-1818
Practice Address - Fax:316-264-3646
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-02-17
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Provider Licenses
StateLicense IDTaxonomies
KS0429446207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSI09444Medicare UPIN