Provider Demographics
NPI:1902605355
Name:MERCHANT, GIBRAN
Entity type:Individual
Prefix:
First Name:GIBRAN
Middle Name:
Last Name:MERCHANT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 E DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3403
Mailing Address - Country:US
Mailing Address - Phone:866-316-3482
Mailing Address - Fax:
Practice Address - Street 1:4326 N MISSION RD
Practice Address - Street 2:
Practice Address - City:BEL AIRE
Practice Address - State:KS
Practice Address - Zip Code:67226-1443
Practice Address - Country:US
Practice Address - Phone:804-477-9055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program