Provider Demographics
NPI:1205335551
Name:BERNARD, ELIAS O (ARRT)
Entity type:Individual
Prefix:
First Name:ELIAS
Middle Name:O
Last Name:BERNARD
Suffix:
Gender:M
Credentials:ARRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 E CENTRAL AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1924
Mailing Address - Country:US
Mailing Address - Phone:316-619-4507
Mailing Address - Fax:
Practice Address - Street 1:6505 E CENTRAL AVE STE 208
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1924
Practice Address - Country:US
Practice Address - Phone:316-619-4507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS22-032802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology