Provider Demographics
NPI:1093338691
Name:DR G MEDICAL PA
Entity Type:Organization
Organization Name:DR G MEDICAL PA
Other - Org Name:RAINBOW ENDOCRINOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBOSOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-217-4827
Mailing Address - Street 1:PO BOX 4056
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66063-4056
Mailing Address - Country:US
Mailing Address - Phone:785-217-4827
Mailing Address - Fax:
Practice Address - Street 1:346 MAINE ST # 160
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1393
Practice Address - Country:US
Practice Address - Phone:785-217-4827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-19
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty