Provider Demographics
NPI:1811948961
Name:UNRUH, ROGER D (DO)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:D
Last Name:UNRUH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 N RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-1570
Mailing Address - Country:US
Mailing Address - Phone:316-773-1212
Mailing Address - Fax:316-440-6601
Practice Address - Street 1:2131 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-1570
Practice Address - Country:US
Practice Address - Phone:316-773-1212
Practice Address - Fax:316-440-6601
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0514944208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS103297OtherBCBS
KS100098390FMedicaid
KS100098390FMedicaid
KS103297Medicare ID - Type Unspecified