Provider Demographics
NPI:1609063312
Name:MAHDI, KHALIDA M
Entity Type:Individual
Prefix:DR
First Name:KHALIDA
Middle Name:M
Last Name:MAHDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KHALIDA
Other - Middle Name:M
Other - Last Name:KADHUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 8035
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-0035
Mailing Address - Country:US
Mailing Address - Phone:316-689-9135
Mailing Address - Fax:
Practice Address - Street 1:3311 E MURDOCK ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3054
Practice Address - Country:US
Practice Address - Phone:316-689-9107
Practice Address - Fax:316-689-9354
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-33778207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200974390AMedicaid
003719259OtherMEDICARE