Provider Demographics
NPI:1851595854
Name:GIANGIACOMO, FAYE C (MD)
Entity Type:Individual
Prefix:DR
First Name:FAYE
Middle Name:C
Last Name:GIANGIACOMO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FAYE
Other - Middle Name:L
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5330 S 900 E STE 120
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-3504
Mailing Address - Country:US
Mailing Address - Phone:801-266-0055
Mailing Address - Fax:801-266-0056
Practice Address - Street 1:929 N ST FRANCIS
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3821
Practice Address - Country:US
Practice Address - Phone:316-268-5426
Practice Address - Fax:316-652-0340
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-35605207ZP0102X
MN105442207ZP0105X
390200000X
KS0435605207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN220001542Medicare PIN