Provider Demographics
NPI:1750752960
Name:WICHITA FOOT AND ANKLE WOUND CENTER
Entity type:Organization
Organization Name:WICHITA FOOT AND ANKLE WOUND CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SURTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:316-755-8004
Mailing Address - Street 1:2522 N GRAYSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67228-8039
Mailing Address - Country:US
Mailing Address - Phone:316-755-8004
Mailing Address - Fax:316-652-9913
Practice Address - Street 1:220 S HILLSIDE ST STE B
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-2151
Practice Address - Country:US
Practice Address - Phone:316-755-8004
Practice Address - Fax:316-652-9913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty