Provider Demographics
NPI:1891288338
Name:KHAMIS, FADDY IMAD (MD)
Entity Type:Individual
Prefix:
First Name:FADDY
Middle Name:IMAD
Last Name:KHAMIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FADDY
Other - Middle Name:IMAD
Other - Last Name:KHAMIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:20805 W 151ST ST STE 224
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7249
Mailing Address - Country:US
Mailing Address - Phone:913-355-8400
Mailing Address - Fax:913-782-1574
Practice Address - Street 1:20805 W 151ST ST STE 224
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7249
Practice Address - Country:US
Practice Address - Phone:913-355-8400
Practice Address - Fax:913-782-1574
Is Sole Proprietor?:No
Enumeration Date:2018-06-10
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-45075207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine