| Concierge Medicine Of Wichita Llc | |
|
9449 E 21st St N Ste. 200 Wichita KS 67206-2969 | |
| (316) 462-1070 | |
| (316) 462-1078 |
| Full Name | Concierge Medicine Of Wichita Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 9449 E 21st St N, Wichita, Kansas |
| Authorized Official Name and Position | Aly A Gadalla (OWNER) |
| Authorized Official Contact | 3164621070 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Concierge Medicine Of Wichita Llc 9449 E 21st St N Ste. 200 Wichita KS 67206-2969 Ph: (316) 462-1070 | Concierge Medicine Of Wichita Llc 9449 E 21st St N Ste. 200 Wichita KS 67206-2969 Ph: (316) 462-1070 |
| NPI Number | 1326399205 |
|---|---|
| Provider Enumeration Date | 10/02/2012 |
| Last Update Date | 11/09/2012 |
| Medicare PECOS PAC ID | 1557513017 |
|---|---|
| Medicare Enrollment ID | O20121207000095 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326399205 | NPI | - | NPPES |
| PENDING | Medicaid | KS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 04-29832 (Kansas) | Primary |
| Provider Name | Aly A Gadalla |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1083693634 PECOS PAC ID: 2466421763 Enrollment ID: I20041001000762 |
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