=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245232842
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT J AIN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2005
-----------------------------------------------------
Last Update Date | 02/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3223 N WEBB RD
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67226-8175
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-462-5072
-----------------------------------------------------
Fax | 316-315-0514
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1111 N PRAIRIE CREEK RD
-----------------------------------------------------
City | ANDOVER
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67002-8486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-371-2827
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 04-29063
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | 04-29063
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------