Provider Demographics
NPI:1205942463
Name:FAIMON, GREGORY G (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:G
Last Name:FAIMON
Suffix:
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 1:3800 E 93RD ST N
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67147-8716
Mailing Address - Country:US
Mailing Address - Phone:316-650-2878
Mailing Address - Fax:
Practice Address - Street 1:2610 N WOODLAWN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-2729
Practice Address - Country:US
Practice Address - Phone:316-858-2610
Practice Address - Fax:316-858-2793
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-27023207PE0004X
KS0427023207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100294640HMedicaid
KS100294640MMedicaid
KSP00615213OtherRR MC (PALMETTO)
KS100294640LMedicaid
KS100294640WMedicaid
KS105234OtherBC/BS OF KANSAS
KS200362720CMedicaid
KSKA1872002Medicare PIN
KS105234Medicare PIN
KSG63689Medicare UPIN
KS200362720CMedicaid
KSKA1187002Medicare PIN
KS004052025Medicare PIN
KS100294640HMedicaid
KSP00640081Medicare PIN