Healthcare Provider Details

I. General information

NPI: 1932639093
Provider Name (Legal Business Name): OMAR ELFANAGELY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 N GREENWICH RD
WICHITA KS
67206-3104
US

IV. Provider business mailing address

1923 N GREENWICH RD
WICHITA KS
67206-3104
US

V. Phone/Fax

Practice location:
  • Phone: 316-305-9618
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number04-53183
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: