DR. CONRADO M AGUSTIN SR. (NPI# 1558468561) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558468561 |
| Entity Type | Individual |
| Full Name | DR. CONRADO M AGUSTIN SR. |
| Credential | M.D. |
| Practice Address |
2707 E 21st St N Wichita KS 67214-2249 |
| Mailing Address |
6905 E Stonegate St Wichita KS 67206-1135 |
| Practice Telephone | 3166910249 |
| Mailing Telephone | 3166813409 |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2012-02-24 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | 04-15625 | KS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KS | 100321990D | 05 | |
| KS | FIRSTGUARD PROVIDER NUMBE | 645010 | 01 |
| KS | 100081020A | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558454686 | Conrado M Agustin Jr. | Pediatrics | 162 N Hillside St, Wichita, KS 67214-4919 | 2006-10-02 |
| Street Address |
2707 E 21ST ST N |
| City | WICHITA |
| State | KS |
| Zip Code | 67214-2249 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043285463 | Stewart E Dismuke | Internal Medicine | 2707 E 21st St N, Wichita, KS 67214-2249 | 2006-02-20 |
| 1528623303 | Jeremiah D Buehner | Physician Assistant | 2707 E 21st St N, Wichita, KS 67214-2249 | 2019-05-07 |
| 1962065151 | Jesse R Welsh | Social Worker | 2707 E 21st St N, Wichita, KS 67214-2249 | 2019-04-15 |
| 1356835359 | Shannon Linnea Pierce | Physician Assistant | 2707 E 21st St N, Wichita, KS 67214-2249 | 2018-06-21 |
| 1316435449 | Danielle Renea Klatt | Nurse Practitioner | 2707 E 21st St N, Wichita, KS 67214-2249 | 2018-04-24 |
| 1497258685 | Brittany N Hill | Nurse Practitioner | 2707 E 21st St N, Wichita, KS 67214-2249 | 2018-03-14 |
| 1316445257 | Kristin Ann Loyd | Nurse Practitioner | 2707 E 21st St N, Wichita, KS 67214 | 2018-01-25 |
| 1285149245 | Jeremy T Hobson | Nurse Practitioner | 2707 E 21st St N, Wichita, KS 67214-2249 | 2017-12-12 |
| 1588177000 | Jennifer L King | Nurse Practitioner | 2707 E 21st St N, Wichita, KS 67214 | 2017-11-06 |
| 1447776588 | Mary Katherine Fesen | Social Worker | 2707 E 21st St N, Wichita, KS 67214-2249 | 2017-08-21 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124591185 | Laquita Patrice Boyede | Durable Medical Equipment & Medical Supplies | 1503 Northeast Parkway, Wichita, KS 67214 | 2019-01-02 |
| 1891270674 | Kathryn Denise Boomer | Physician Assistant | 929 St. Francis N, Wichita, KS 67214 | 2018-09-27 |
| 1447756457 | Cardinal Health 132 LLC | Pharmacy | 527 N Grove Street, Suite 100, Wichita, KS 67214 | 2018-03-30 |
| 1023517174 | Laboratory Corporation of America Holdings | Clinical Medical Laboratory | 3243 E Murdock Street, Level G, Wichita, KS 67214 | 2018-02-05 |
| 1558887901 | Shonnetta Lachan Gabriel | Counselor | 2707 E. 21st St. N, Wichita, KS 67214 | 2017-08-17 |
| 1417492174 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 803 N Broadway Ave, Wichita, KS 67214 | 2017-01-04 |
| 1952850653 | Rachel J Johnson | Counselor | 805 N Volutsia, Wichita, KS 67214 | 2016-09-23 |
| 1063899813 | Christy Lee Foos | Social Worker | 2707 E. 21st St. North, Healthcore Clinic, Wichita, KS 67214 | 2015-04-30 |
| 1952708018 | William Schroeder Fargo | Specialist | 701 N. Emporia, Wichita, KS 67214 | 2014-12-04 |
| 1447692710 | Valeriya V Hunter | Dentist | 527 N Grove, Wichita, KS 67214 | 2013-07-26 |
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| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023308939 | Damen Wayne Hershberger | Obstetrics & Gynecology | 9300 E 29th St N Ste 320, Wichita, KS 67226-2184 | 2011-04-12 |
| 1053639807 | Preferred Medical Associates | Obstetrics & Gynecology | 14700 W. St. Teresa, Ste. 370, Wichita, KS 67235-9600 | 2010-05-04 |
| 1659547479 | Lueke B Lueken | Obstetrics & Gynecology | 2760 S Roosevelt St, Wichita, KS 67210-1304 | 2008-05-01 |
| 1073783437 | Veerayyagari Annapurna | Obstetrics & Gynecology | 9300 E 29th St N Ste 201, Wichita, KS 67226-2183 | 2008-03-01 |
| 1417068727 | Victoria W Kindel | Obstetrics & Gynecology | 3232 E Murdock, Wichita, KS 67208-3003 | 2006-08-31 |
| 1821008285 | Michael D Wolfe | Obstetrics & Gynecology | 1515 S Clifton Ave Ste 400, Wichita, KS 67218-2961 | 2006-08-09 |
| 1801814934 | Steven L Zielke | Obstetrics & Gynecology | 5109 W Wavecrest Cir, Wichita, KS 67205-1322 | 2006-07-17 |
| 1699709923 | Women's Medcenter, Pa | Obstetrics & Gynecology | 223 S Hillside St, Wichita, KS 67211-2128 | 2006-07-11 |
| 1700840550 | Valerie Elizabeth Drake-albert | Obstetrics & Gynecology | 1855 N Webb Rd, Wichita, KS 67206-3413 | 2006-04-17 |
| 1992700710 | Michael D Bates | Obstetrics & Gynecology | 9300 E 29th St N, Ste 201, Wichita, KS 67226-2183 | 2005-06-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.