Provider Demographics
NPI:1316139439
Name:LAPORE, SERVILLANO M (RPT)
Entity type:Individual
Prefix:MR
First Name:SERVILLANO
Middle Name:M
Last Name:LAPORE
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12007 W HARDTNER CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-1315
Mailing Address - Country:US
Mailing Address - Phone:316-722-2295
Mailing Address - Fax:316-722-2295
Practice Address - Street 1:116 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MULVANE
Practice Address - State:KS
Practice Address - Zip Code:67110-1718
Practice Address - Country:US
Practice Address - Phone:316-777-0977
Practice Address - Fax:316-777-9742
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01846208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation