Provider Demographics
NPI:1003867953
Name:LAKIN, GREGORY F (DO, JD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:F
Last Name:LAKIN
Suffix:
Gender:M
Credentials:DO, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 N TOPEKA ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3620
Mailing Address - Country:US
Mailing Address - Phone:316-201-1234
Mailing Address - Fax:
Practice Address - Street 1:933 N TOPEKA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3620
Practice Address - Country:US
Practice Address - Phone:316-201-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0528419207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100372970EMedicaid
KS103296OtherBCBS
KS100372970EMedicaid
KS100372970EMedicaid