| NPI | 1215467584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER BAHNMAIER Insurance Credentialing Specialist 785-505-2988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2025-02-11 |