Individual
WILLIAM PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
550 N HILLSIDE ST, WICHITA, KS 67214-4910
(316) 962-3150
(316) 962-7334
Mailing address
PO BOX 47490, WICHITA, KS 67201-7490
(316) 962-3150
(316) 962-7334
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
04-29130
KS
208000000X
Pediatrics Physician
04-29130
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100397190B
—
KS
01
—
103059
BLUE CROSS BLUE SHIELD
KS
01
—
203466
HEALTH PARTNERS OF KANSAS
KS
01
—
411471
FIRSTGUARD
KS
Enumeration date
04/19/2006
Last updated
10/17/2016
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