Provider Demographics
NPI:1104025949
Name:SALIBA, WISSAM (MD)
Entity Type:Individual
Prefix:
First Name:WISSAM
Middle Name:
Last Name:SALIBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 N EMPORIA ST STE 310
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3727
Mailing Address - Country:US
Mailing Address - Phone:316-263-5891
Mailing Address - Fax:316-263-3083
Practice Address - Street 1:818 N EMPORIA ST STE 310
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3727
Practice Address - Country:US
Practice Address - Phone:316-263-5891
Practice Address - Fax:316-263-3083
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS046836207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine