Provider Demographics
NPI:1093245979
Name:ENDOCRINE CENTER OF KANSAS, LLC
Entity Type:Organization
Organization Name:ENDOCRINE CENTER OF KANSAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:MORTADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-518-7737
Mailing Address - Street 1:9300 E 29TH ST N STE 204
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2183
Mailing Address - Country:US
Mailing Address - Phone:316-500-6000
Mailing Address - Fax:316-444-0409
Practice Address - Street 1:9300 E 29TH ST N STE 204
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2183
Practice Address - Country:US
Practice Address - Phone:316-500-6000
Practice Address - Fax:316-444-0409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-35481207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty