Provider Demographics
NPI:1457764532
Name:ENNS, PAUL ALAN (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ALAN
Last Name:ENNS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 W VILLAGE CIR STE 1
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-9364
Mailing Address - Country:US
Mailing Address - Phone:316-838-2020
Mailing Address - Fax:316-838-7574
Practice Address - Street 1:7550 W VILLAGE CIR STE 1
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-9364
Practice Address - Country:US
Practice Address - Phone:316-838-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9408351207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery