Provider Demographics
NPI:1407893290
Name:BEDROS, FADI V (MD)
Entity Type:Individual
Prefix:
First Name:FADI
Middle Name:V
Last Name:BEDROS
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 1:1133 COLLEGE AVE
Mailing Address - Street 2:BUILDING B, SUITE 100
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2770
Mailing Address - Country:US
Mailing Address - Phone:785-565-9500
Mailing Address - Fax:785-565-9595
Practice Address - Street 1:1133 COLLEGE AVE
Practice Address - Street 2:BUILDING B, SUITE 100
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2770
Practice Address - Country:US
Practice Address - Phone:785-565-9500
Practice Address - Fax:785-565-9595
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-32696207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2568592Medicaid
OHH02555Medicare UPIN
OHBE4143211Medicare ID - Type Unspecified