Provider Demographics
NPI:1073026100
Name:ELAGAB, AHMED (MBBS)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:
Last Name:ELAGAB
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3226 S HANDLEY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-3359
Mailing Address - Country:US
Mailing Address - Phone:316-665-2106
Mailing Address - Fax:
Practice Address - Street 1:345 N RIVERVIEW ST STE 600
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4265
Practice Address - Country:US
Practice Address - Phone:316-616-6169
Practice Address - Fax:316-616-6161
Is Sole Proprietor?:No
Enumeration Date:2017-11-11
Last Update Date:2017-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001480OtherSUDANESE MEDICAL BOARD