Healthcare Provider Details

I. General information

NPI: 1104231216
Provider Name (Legal Business Name): MAHEEDHAR GEDELA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
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: 316-651-2660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number04-48053
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number04-48053
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04-48053
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: