Provider Demographics
NPI:1649650995
Name:ABDEL JAWAD, MOHAMMAD ALI
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:ALI
Last Name:ABDEL JAWAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6516 W PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-5100
Mailing Address - Country:US
Mailing Address - Phone:505-900-7814
Mailing Address - Fax:
Practice Address - Street 1:929 N SAINT FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3821
Practice Address - Country:US
Practice Address - Phone:316-268-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2023-05-25
Deactivation Date:2016-01-19
Deactivation Code:
Reactivation Date:2016-03-15
Provider Licenses
StateLicense IDTaxonomies
KS04-40568207R00000X, 208M00000X
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program