Individual
THOMAS S IVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
7111 E 21ST ST N STE A, WICHITA, KS 67206-1078
(316) 684-2851
(316) 683-5239
Mailing address
7111 E 21ST ST N STE A, WICHITA, KS 67206-1078
(316) 684-2851
(316) 683-5239
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
05-50713
KS
207Q00000X
Family Medicine Physician
4082
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200076860A
—
OK
Enumeration date
05/03/2006
Last updated
04/10/2025
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