Basic Information
| Provider Information | |||||||||
| NPI: | 1528263043 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEUTSCH | ||||||||
| FirstName: | JEREMY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 818 N EMPORIA ST | ||||||||
| Address2: | SUITE 403 | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672143729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162624467 | ||||||||
| FaxNumber: | 3162620706 | ||||||||
| Practice Location | |||||||||
| Address1: | 818 N EMPORIA ST | ||||||||
| Address2: | SUITE 403 | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672143729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162624467 | ||||||||
| FaxNumber: | 3162620706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2007 | ||||||||
| LastUpdateDate: | 09/25/2013 | ||||||||
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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 | 207RH0003X | 39014 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 04-33369 | KS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207R00000X | 04-33369 | KS | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200575450C | 05 | KS | MEDICAID | 04-33369 | 01 | KANSAS LICENSE | OTHER |