Organization
CONCIERGE MEDICINE OF WICHITA LLC
Active
Organization
CONCIERGE MEDICINE OF WICHITA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALY A GADALLA MD (OWNER)
(316) 462-1070
Entity
Organization
Contact information
Practice address
9449 E 21ST ST N, STE. 200, WICHITA, KS 67206-2969
(316) 462-1070
(316) 462-1078
Mailing address
9449 E 21ST ST N, STE. 200, WICHITA, KS 67206-2969
(316) 462-1070
(316) 462-1078
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
04-29832
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
KS
Enumeration date
10/02/2012
Last updated
11/09/2012
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