Basic Information
| Provider Information | |||||||||
| NPI: | 1841252566 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRESKORN | ||||||||
| FirstName: | SHELDON | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 N KANSAS | ||||||||
| Address2: | SUITE #3049 | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672143199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162932647 | ||||||||
| FaxNumber: | 3162931863 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 N MINNEAPOLIS | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672143124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3162932647 | ||||||||
| FaxNumber: | 3162931863 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 01/04/2008 | ||||||||
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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 | 2084P0800X | 0416344 | KS | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0805X | 0416344 | KS | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 003476 | 01 | KS | BCBS | OTHER |