Provider Demographics
NPI:1215377734
Name:KISANG, GILBERT CHESIRE
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:CHESIRE
Last Name:KISANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GILBERT
Other - Middle Name:CHESIRE
Other - Last Name:KISANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 5183
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5183
Mailing Address - Country:US
Mailing Address - Phone:303-306-7101
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:550 N HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4910
Practice Address - Country:US
Practice Address - Phone:316-962-2000
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9408067207R00000X
KS04-39632208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS04-39632OtherKANSAS MEDICAL LICENSE