Illera, Vivian A
Illera, Vivian A is an individual health care provider with primary practice located at 1921 N Webb Rd , Wichita KS 67206-3405. She recently has only one registered license in Allopathic & Osteopathic Physicians / Rheumatology, which is considered as her primary health care specialty. Illera, Vivian A can be contacted via phone (316) 612-4815.Contact Information
Primary practice address
1921 N Webb Rd
Wichita KS 67206-3405
Phone: (316) 612-4815
Fax: (316) 681-0244
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Rheumatology | 207RR0500X | 04-25436 | Kansas |
Profile Details
| NPI number | 1790741148 |
|---|---|
| LBN Legal business name | Illera, Vivian A |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 25th, 2006 |
| Last updated | Jul 11th, 2011 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1790741148 | NPPES |
| Kansas | MEDICAID | 100170460B |
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