Provider Demographics
NPI:1215034780
Name:FABIAN, CAROL J (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:FABIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 SHAWNEE MISSION PKWY
Mailing Address - Street 2:SUITE 210, MS 5003
Mailing Address - City:WESTWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2005
Mailing Address - Country:US
Mailing Address - Phone:913-588-6029
Mailing Address - Fax:
Practice Address - Street 1:2330 SHAWNEE MISSION PKWY
Practice Address - Street 2:SUITE 210 MS 5003
Practice Address - City:WESTWOOD
Practice Address - State:KS
Practice Address - Zip Code:66205-2005
Practice Address - Country:US
Practice Address - Phone:913-588-6029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-16438207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO06691035OtherBCBS KC
KS100195350AMedicaid
MO200981801Medicaid
KS663870OtherFIRSTGUARD
KS0116357AMedicare ID - Type Unspecified
MO200981801Medicaid
KS110121084Medicare ID - Type UnspecifiedRAILROAD MEDICARE