Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 04-42311 | KS |
N | 111NI0900X | Internist | 04-42311 | KS |
N | 207RC0000X | Internist - Cardiovascular Disease | 04-42311 | KS |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 04-42311 | KS |
NPI | 1053609321 |
---|---|
Provider Name | Madan Mohan Acharya |
First Address | Wichita, KS 67226-8127 |
Second Address | Wichita, KS 67226-8127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2011 |
Last Update Date | 11/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (05) | KS |