Basic Information
| Provider Information | |||||||||
| NPI: | 1205942463 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAIMON | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3800 E 93RD ST N | ||||||||
| Address2: | |||||||||
| City: | VALLEY CENTER | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671478716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166502878 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2610 N WOODLAWN ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672202729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3168582610 | ||||||||
| FaxNumber: | 3168582793 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 12/22/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 04-27023 | KS | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 207P00000X | 0427023 | KS | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100294640H | 05 | KS | MEDICAID | 100294640M | 05 | KS | MEDICAID | P00615213 | 01 | KS | RR MC (PALMETTO) | OTHER | 100294640L | 05 | KS | MEDICAID | 100294640W | 05 | KS | MEDICAID | 105234 | 01 | KS | BC/BS OF KANSAS | OTHER | 200362720C | 05 | KS | MEDICAID |