Provider Demographics
NPI:1972729523
Name:HOMAN, GRETCHEN JABARA (MD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:JABARA
Last Name:HOMAN
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 1:620 N CARRIAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4501
Mailing Address - Country:US
Mailing Address - Phone:316-962-3100
Mailing Address - Fax:316-962-3132
Practice Address - Street 1:620 N CARRIAGE PKWY
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4501
Practice Address - Country:US
Practice Address - Phone:316-962-3100
Practice Address - Fax:316-962-3132
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0432259208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS106896OtherMEDICARE
KS2851379OtherUNITED HEALTH CARE
KS106558OtherHEALTH PARTNERS OF KANSAS
KS0000106896OtherBLUE CROSS /BLUE SHIELD
KS200533360AMedicaid