| Glutality Provider Group Of Kansas, Pa. | |
|
801 E Douglas Ave Fl 2 Wichita KS 67202-3548 | |
| (561) 678-2026 | |
| Not Available |
| Full Name | Glutality Provider Group Of Kansas, Pa. |
|---|---|
| Speciality | Internal Medicine |
| Location | 801 E Douglas Ave Fl 2, Wichita, Kansas |
| Authorized Official Name and Position | Mark Mitchell (OWNER) |
| Authorized Official Contact | 5616782026 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Glutality Provider Group Of Kansas, Pa. 401 Fairway Dr Ste 200 Deerfield Beach FL 33441-1800 Ph: (561) 678-2026 | Glutality Provider Group Of Kansas, Pa. 801 E Douglas Ave Fl 2 Wichita KS 67202-3548 Ph: (561) 678-2026 |
| NPI Number | 1467042754 |
|---|---|
| Provider Enumeration Date | 01/21/2021 |
| Last Update Date | 11/08/2021 |
| Medicare PECOS PAC ID | 5193132876 |
|---|---|
| Medicare Enrollment ID | O20210324002144 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467042754 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Carolyn Waldo |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1447266234 PECOS PAC ID: 0345209888 Enrollment ID: I20041008000859 |
| Provider Name | Mark Mitchell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1003833633 PECOS PAC ID: 2264333632 Enrollment ID: I20210324002344 |
| Provider Name | Sachin Parekh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285749952 PECOS PAC ID: 6204832314 Enrollment ID: I20210402000316 |
| Provider Name | Eric Thomas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528378072 PECOS PAC ID: 1153503891 Enrollment ID: I20210406000563 |
| Provider Name | Iwan Nyotowidjojo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578976270 PECOS PAC ID: 3274859970 Enrollment ID: I20230504002415 |
| Provider Name | Ana Lisa Carr |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689841744 PECOS PAC ID: 2567741580 Enrollment ID: I20230519000393 |
| Provider Name | Ashwin Narayana |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245624188 PECOS PAC ID: 4082989207 Enrollment ID: I20230523000375 |
| Provider Name | Bhavesh Patel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831534957 PECOS PAC ID: 8224351549 Enrollment ID: I20230605001463 |
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