MEDICARE: DR. ALY A GADALLA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	04-29832	KS
2	207P00000X	Emergency Medicine Physician	0429832	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083693634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALY A GADALLA MD

Provider Business Mailing Address
First Line	:	1861 N ROCK RD STE 100
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-1264
Country	:	US
Telephone Number	:	316-462-1070
Fax Number	:	316-462-1078

Provider Business Practice Location Address
First Line	:	1861 N ROCK RD STE 100
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67206-1264
Country	:	US
Telephone Number	:	316-462-1070
Fax Number	:	316-462-1078

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	04/01/2024

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