Provider Demographics
NPI:1407829161
Name:EL ATROUNI, WISSAM I (MD)
Entity type:Individual
Prefix:
First Name:WISSAM
Middle Name:I
Last Name:EL ATROUNI
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 1:3901 RAINBOW BOULEVARD
Mailing Address - Street 2:6067 DELP, MAIL STOP 1028
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-6035
Mailing Address - Fax:913-945-6916
Practice Address - Street 1:3901 RAINBOW BOULEVARD
Practice Address - Street 2:6067 DELP, MAIL STOP 1028
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-6035
Practice Address - Fax:913-945-6916
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-32882207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS04-32882OtherMEDICAL LICENSE NUMBER
KS200564430AMedicaid
KS200564430AMedicaid