Provider Demographics
NPI:1477547727
Name:KANSAS GASTROENTEROLOGY LLC
Entity Type:Organization
Organization Name:KANSAS GASTROENTEROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ESTEPHAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:ZAYAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-261-3130
Mailing Address - Street 1:PO BOX 47572
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-7572
Mailing Address - Country:US
Mailing Address - Phone:316-261-3130
Mailing Address - Fax:316-261-3275
Practice Address - Street 1:848 N SAINT FRANCIS ST
Practice Address - Street 2:SUITE 2945
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3800
Practice Address - Country:US
Practice Address - Phone:316-261-3130
Practice Address - Fax:316-261-3275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200253030AMedicaid