Individual
JOHN SHELLITO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1947 FOUNDERS ST, WICHITA, KS 67206-3548
(316) 689-9124
(316) 613-4608
Mailing address
PO BOX 8035, WICHITA, KS 67208-0035
(316) 689-9135
(316) 689-9102
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
20502
KS
2086S0129X
Vascular Surgery Physician
20502
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003429
BCBS
KS
05
—
100147290C
—
KS
01
—
12149403
MULTIPLAN
KS
01
—
16923
COVENTRY
KS
01
—
200152
HPK
KS
01
—
836
PHS
KS
Enumeration date
07/05/2006
Last updated
02/06/2015
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