Individual
KENNETH D DYKSTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3243 E MURDOCK ST, SUITE #500, WICHITA, KS 67208-3052
(316) 962-2080
(316) 962-2079
Mailing address
3243 E MURDOCK ST, SUITE #500, WICHITA, KS 67208-3052
(316) 962-2080
(316) 962-2079
Taxonomy
Speciality
Code
Description
License number
State
2080P0205X
Pediatric Endocrinology Physician
Primary
28093
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
055541
BCBS
KS
05
—
100333960A
—
KS
01
—
11872
PHS
KS
01
—
12149357
MULTIPLAN
KS
01
—
16997
COVENTRY
KS
01
—
200626
HPK
KS
Enumeration date
07/03/2006
Last updated
02/03/2012
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