Provider Demographics
NPI:1770080673
Name:WICHITA DIABETES AND ENDOCRINOLOGY, LLC
Entity type:Organization
Organization Name:WICHITA DIABETES AND ENDOCRINOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AUBRY
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:BOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-330-3636
Mailing Address - Street 1:8110 E 32ND ST N STE 125
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2623
Mailing Address - Country:US
Mailing Address - Phone:316-330-3636
Mailing Address - Fax:844-322-8797
Practice Address - Street 1:8110 E 32ND ST N STE 125
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2644
Practice Address - Country:US
Practice Address - Phone:316-330-3636
Practice Address - Fax:866-378-4552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty