Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 04-18244 | KS |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 04-18244 | KS |
N | 207QS0010X | Family Doctor - Sports Medicine | 04-18244 | KS |
NPI | 1316956055 |
---|---|
Provider Name | Edward John Lind II |
First Address | Wichita, KS 67218 |
Second Address | Wichita, KS 67218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 06/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
057455 | BC/BS (01) | KS |
080147935 | MEDICARE RAILROAD (01) | KS |
B91247 | (02) | KS |