Basic Information
| Provider Information | |||||||||
| NPI: | 1942646252 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KALU | ||||||||
| FirstName: | WALTER | ||||||||
| MiddleName: | KALU | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1515 S CLIFTON AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672182953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3168580550 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1515 S CLIFTON AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3168580550 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2013 | ||||||||
| LastUpdateDate: | 03/07/2019 | ||||||||
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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 | 04-38972 | KS | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 201147480B | 05 | KS | MEDICAID |