Healthcare Provider Details

I. General information

NPI: 1659424471
Provider Name (Legal Business Name): MOHAMED NIZAR N. MAHOMED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6705 HERITAGE PKWY STE 202
ROCKWALL TX
75087-8729
US

IV. Provider business mailing address

7550 W VILLAGE CIR SUITE 1
WICHITA KS
67205-9363
US

V. Phone/Fax

Practice location:
  • Phone: 469-800-7200
  • Fax: 469-800-7210
Mailing address:
  • Phone: 316-838-2020
  • Fax: 316-838-7574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number0434320
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: