Basic Information
| Provider Information | |||||||||
| NPI: | 1053393199 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENNING | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 645 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672010645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166896173 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3600 E HARRY ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672183713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166896173 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2005 | ||||||||
| LastUpdateDate: | 10/06/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 04-21883 | KS | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 04-21883 | KS | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085U0001X | 0421883 | KS | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 2085B0100X | 0421883 | KS | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0700X | 0421883 | KS | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085P0229X | 0421883 | KS | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0203X | 0421883 | KS | N | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 100122240H | 05 | KS | MEDICAID |