Basic Information
| Provider Information | |||||||||
| NPI: | 1326075037 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUNIVEN | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | LOREN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | TOPEKA VA MEDICAL CTR | ||||||||
| Address2: | 2200 GAGE BLVD. | ||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666220001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7853503111 | ||||||||
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| Practice Location | |||||||||
| Address1: | TOPEKA VA MEDICAL CTR | ||||||||
| Address2: | 2200 GAGE BLVD. | ||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666220001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7853503111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 05/13/2009 | ||||||||
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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 | 04-19330 | KS | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 052496 | 01 | KS | BC/BS PREMIER BLUE | OTHER | 100129540C | 05 | KS | MEDICAID |