Provider Demographics
NPI:1952378515
Name:BAADE, LYLE E (PHD)
Entity Type:Individual
Prefix:
First Name:LYLE
Middle Name:E
Last Name:BAADE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1010 N KANSAS
Mailing Address - Street 2:SUITE 3049
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3199
Mailing Address - Country:US
Mailing Address - Phone:316-293-2647
Mailing Address - Fax:316-293-1882
Practice Address - Street 1:7829 E ROCKHILL ST
Practice Address - Street 2:SUITE #105
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3920
Practice Address - Country:US
Practice Address - Phone:316-293-3850
Practice Address - Fax:316-683-6733
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0460103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100237670CMedicaid
KS004416OtherBCBS
KS004416Medicare PIN
R30849Medicare UPIN