Basic Information
Provider Information
NPI: 1497168777
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHAMBERS
FirstName: ISAAC
MiddleName: MATTHEW
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1010 N KANSAS ST
Address2:  
City: WICHITA
State: KS
PostalCode: 672143124
CountryCode: US
TelephoneNumber: 3162932665
FaxNumber:  
Practice Location
Address1: 2220 CANTERBURY DR
Address2:  
City: HAYS
State: KS
PostalCode: 676012370
CountryCode: US
TelephoneNumber: 7856235775
FaxNumber: 7856235774
Other Information
ProviderEnumerationDate: 06/04/2014
LastUpdateDate: 08/05/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/05/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003X0438241KSY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

No ID Information.


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