Provider Demographics
NPI:1942520804
Name:LEVIN, KYLEE (MD)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:LEVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1947 N FOUNDERS CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3548
Mailing Address - Country:US
Mailing Address - Phone:316-613-4930
Mailing Address - Fax:316-613-4937
Practice Address - Street 1:1947 N FOUNDERS CIR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3548
Practice Address - Country:US
Practice Address - Phone:316-613-4930
Practice Address - Fax:316-613-4937
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7407207L00000X
KS04-37777207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200592040AMedicaid
KS003719391Medicare Oscar/Certification