Healthcare Provider Details

I. General information

NPI: 1720501588
Provider Name (Legal Business Name): AHMED HATEM MOHAMED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 N WEBB RD
WICHITA KS
67226-8127
US

IV. Provider business mailing address

3535 N WEBB RD
WICHITA KS
67226-8127
US

V. Phone/Fax

Practice location:
  • Phone: 316-686-5300
  • Fax: 316-651-2660
Mailing address:
  • Phone: 316-686-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-49547
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number04-49547
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number04-49547
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: