Tiffany Bouddhara, MD
Individual provider Active NPI Obstetrics & Gynecology Physician · Wichita, KS
NPI 1558045492 · NPPES record last updated Jun 12, 2023
Key facts
- NPI
- 1558045492
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 94-11585 (KS)
- Practice address
- 1010 N Kansas St
Wichita, KS 67214-3124 - Phone
- (316) 293-2665
- NPI assigned
- Jun 12, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230721000680 | KS | Order and Referring Only - Obstetrics/Gynecology |
7911367925 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Interoperability endpoints
- tiffany.bouddhara@hca3.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 94-11585 | KS | Yes |
Addresses
Primary practice location
1010 N Kansas St
Wichita, KS 67214-3124
Mailing address
1010 N Kansas St
Wichita, KS 67214-3124
Phone (316) 293-2665
Other providers in Wichita, KS
- Trisha L Bosken
- Kresta L Bosley
- Autumn Boss
- Abigail Boswell
- Maged Botros
- Emily Ann Boughton
- Nour Boulad
- Jessica Anne Boulware
- Casandra Lynn Bourn
- Linda Jean Bourn
All providers in Wichita, KS · Obstetrics & Gynecology Physician in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 12, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.