Individual
DR. CONRADO M AGUSTIN SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2707 E 21ST ST N, WICHITA, KS 67214-2249
(316) 691-0249
Mailing address
6905 E STONEGATE ST, WICHITA, KS 67206-1135
(316) 681-3409
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
04-15625
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100081020A
—
KS
05
—
100321990D
—
KS
01
—
645010
FIRSTGUARD PROVIDER NUMBE
KS
Enumeration date
09/20/2006
Last updated
02/24/2012
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