Provider Demographics
NPI:1316202096
Name:AFANEH, KHALID FATHI ABD-AL RAUOOF (M,BB,S)
Entity Type:Individual
Prefix:DR
First Name:KHALID
Middle Name:FATHI ABD-AL RAUOOF
Last Name:AFANEH
Suffix:
Gender:M
Credentials:M,BB,S
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 3462
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-3462
Mailing Address - Country:US
Mailing Address - Phone:800-373-4222
Mailing Address - Fax:316-652-0340
Practice Address - Street 1:9300 E 29TH ST N STE 208
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:800-373-4222
Practice Address - Fax:316-652-0340
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0440684207ZH0000X, 207ZP0102X
NY63165390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty