Provider Demographics
NPI:1336172014
Name:AL-AHDAB, MOHAMAD KHALED (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:KHALED
Last Name:AL-AHDAB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MO
Other - Middle Name:
Other - Last Name:AHDAB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7015 E CENTRAL AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1943
Mailing Address - Country:US
Mailing Address - Phone:316-440-8800
Mailing Address - Fax:316-440-8802
Practice Address - Street 1:7015 E. CENTRAL
Practice Address - Street 2:SUITE 2
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1946
Practice Address - Country:US
Practice Address - Phone:316-440-8800
Practice Address - Fax:316-440-8802
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361050042080P0202X
KS04-320742080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKS1949OtherPTAN
OK200096860BMedicaid
KS200414260CMedicaid
KSI23720Medicare UPIN
KS200414260CMedicaid