Provider Demographics
NPI:1932175213
Name:TATPATI MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:TATPATI MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TATPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-689-6803
Mailing Address - Street 1:1515 S CLIFTON AVE
Mailing Address - Street 2:460
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2900
Mailing Address - Country:US
Mailing Address - Phone:316-689-6803
Mailing Address - Fax:316-689-0818
Practice Address - Street 1:1515 S CLIFTON AVE
Practice Address - Street 2:460
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2900
Practice Address - Country:US
Practice Address - Phone:316-689-6803
Practice Address - Fax:316-689-0818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17942174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSB68169Medicare UPIN
KS110694Medicare ID - Type Unspecified