Individual
VIVIAN A ILLERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1921 N WEBB RD, WICHITA, KS 67206-3405
(316) 612-4815
(316) 681-0244
Mailing address
1921 N WEBB RD, WICHITA, KS 67206-3405
(316) 612-4815
(316) 681-0244
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
04-25436
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100170460B
—
KS
Enumeration date
04/25/2006
Last updated
07/11/2011
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