Provider Demographics
NPI:1578001160
Name:MAHDI, LAITH MOHAMED (DO)
Entity Type:Individual
Prefix:DR
First Name:LAITH
Middle Name:MOHAMED
Last Name:MAHDI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8412 E WILLOW WOOD ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-7660
Mailing Address - Country:US
Mailing Address - Phone:319-400-0387
Mailing Address - Fax:
Practice Address - Street 1:2301 HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-1253
Practice Address - Country:US
Practice Address - Phone:319-400-0387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-03
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-05997207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine