Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 26205 | KS |
NPI | 1023053683 |
---|---|
Provider Name | Jozef S Mruk |
First Address | Wichita, KS 67208-0035 |
Second Address | Wichita, KS 67208-3054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 09/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
058674 | BCBS (01) | KS |
100185550C | (05) | KS |
12149464 | MULTIPLAN (01) | KS |
12961 | PHS (01) | KS |
17015 | COVENTRY (01) | KS |
202931 | HPK (01) | KS |
E63791 | (02) |