Healthcare Provider Details

I. General information

NPI: 1306813571
Provider Name (Legal Business Name): JOHN W FANNING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9828 E SHANNON WOODS CIR # 100
WICHITA KS
67226-4100
US

IV. Provider business mailing address

9828 E SHANNON WOODS CIR # 100
WICHITA KS
67226-4100
US

V. Phone/Fax

Practice location:
  • Phone: 316-631-1600
  • Fax: 316-631-1617
Mailing address:
  • Phone: 316-631-1600
  • Fax: 316-631-1617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number04-22803
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: