Healthcare Provider Details

I. General information

NPI: 1962403139
Provider Name (Legal Business Name): RICHARD S FAIRCHILD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6730 SW 29TH ST.
TOPEKA KS
66614-0000
US

IV. Provider business mailing address

DEPT CH 14389
PALATINE IL
60055-4389
US

V. Phone/Fax

Practice location:
  • Phone: 785-272-2240
  • Fax: 785-272-2250
Mailing address:
  • Phone: 785-295-5307
  • Fax: 785-231-5991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number04-16750
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: