Provider Demographics
NPI:1255530788
Name:OHLDE, MICHAEL PAUL (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PAUL
Last Name:OHLDE
Suffix:
Gender:M
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:OHLDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:250 N ROCK RD STE 170
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2287
Mailing Address - Country:US
Mailing Address - Phone:316-358-7257
Mailing Address - Fax:316-358-7002
Practice Address - Street 1:250 N ROCK RD STE 170
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2287
Practice Address - Country:US
Practice Address - Phone:316-358-7257
Practice Address - Fax:316-358-7002
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-14
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2156103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS2007707108Medicaid
12522771OtherCAQH