Organization
MEDICINE AND NEPHROLOGY CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NDUBUEZE FIDELIS OKONKWO M.D (OWNER)
(316) 452-5455
Entity
Organization
Contact information
Practice address
700 W CENTRAL AVE STE 206, EL DORADO, KS 67042-2186
(316) 452-5455
(316) 321-0503
Mailing address
700 W CENTRAL AVE STE 206, EL DORADO, KS 67042-2186
(316) 452-5455
(316) 321-0503
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RN0300X
Nephrology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972118
—
LA
Enumeration date
10/21/2016
Last updated
11/01/2016
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