Provider Demographics
NPI:1013949338
Name:ABAY, EUSTAQUIO O II (MD)
Entity Type:Individual
Prefix:
First Name:EUSTAQUIO
Middle Name:O
Last Name:ABAY
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 E DOUGLAS AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1037
Mailing Address - Country:US
Mailing Address - Phone:316-425-0005
Mailing Address - Fax:316-425-0007
Practice Address - Street 1:3305 E DOUGLAS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1037
Practice Address - Country:US
Practice Address - Phone:316-425-0005
Practice Address - Fax:316-425-0007
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0421083174400000X
KS04-21083207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100204380CMedicaid
KS104489Medicare ID - Type Unspecified
KS100204380CMedicaid
B91224Medicare UPIN