Healthcare Provider Details

I. General information

NPI: 1174720205
Provider Name (Legal Business Name): RAMI MORTADA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 E 29TH ST N STE 204
WICHITA KS
67226-2183
US

IV. Provider business mailing address

9300 E 29TH ST N STE 204
WICHITA KS
67226-2183
US

V. Phone/Fax

Practice location:
  • Phone: 316-500-6000
  • Fax: 888-698-4752
Mailing address:
  • Phone: 316-500-6000
  • Fax: 888-698-4752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number04-35481
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: