Provider Demographics
NPI:1285843557
Name:IZARD, AHMAD Y (MD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:Y
Last Name:IZARD
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:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-0645
Mailing Address - Country:US
Mailing Address - Phone:316-689-5050
Mailing Address - Fax:316-689-5050
Practice Address - Street 1:3600 E HARRY ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-3713
Practice Address - Country:US
Practice Address - Phone:316-689-5050
Practice Address - Fax:316-689-6192
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-76772085R0202X
KS04-343162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200654710BMedicaid
KS110297015Medicare PIN