Organization
ENNOBLE HC KS II LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK BRADSHAW MD (PHYSICIAN)
(551) 295-8223
Entity
Organization
Contact information
Practice address
801 E DOUGLAS AVE FL 2ND, WICHITA, KS 67202-3515
(551) 295-8223
Mailing address
2 UNIVERSITY PLZ STE 204, HACKENSACK, NJ 07601-6211
(551) 295-8223
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
07/22/2025
Last updated
08/01/2025
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