Provider Demographics
NPI:1952496937
Name:GALVAN, ALONSO (MD)
Entity Type:Individual
Prefix:
First Name:ALONSO
Middle Name:
Last Name:GALVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALONSO
Other - Middle Name:MENDIELA
Other - Last Name:GALVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 764
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-0764
Mailing Address - Country:US
Mailing Address - Phone:316-683-5556
Mailing Address - Fax:316-683-5479
Practice Address - Street 1:1431 S BLUFFVIEW DR
Practice Address - Street 2:STE. 102
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-3039
Practice Address - Country:US
Practice Address - Phone:316-683-5556
Practice Address - Fax:316-683-5479
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-15579207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100081430 BMedicaid
052712Medicare ID - Type Unspecified
B68231Medicare UPIN