Organization
ADVANCED MENS HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLAY E LYDDANE MD, PHD (OWNER)
(316) 722-4725
Entity
Organization
Contact information
Practice address
3460 N RIDGE ROAD #90, WICHITA, KS 67205-1222
(316) 689-9185
(316) 616-2095
Mailing address
241 N HILLSIDE, WICHITA, KS 67214-6627
(316) 776-9495
(316) 616-2095
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0435145
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200740730A
—
KS
Enumeration date
03/14/2016
Last updated
03/14/2016
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