Provider Demographics
NPI:1659424471
Name:MAHOMED, MOHAMED NIZAR N (MD)
Entity type:Individual
Prefix:
First Name:MOHAMED NIZAR
Middle Name:N
Last Name:MAHOMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7550 W VILLAGE CIR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-9363
Mailing Address - Country:US
Mailing Address - Phone:316-838-2020
Mailing Address - Fax:316-838-7574
Practice Address - Street 1:6705 HERITAGE PKWY STE 202
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-8729
Practice Address - Country:US
Practice Address - Phone:469-800-7200
Practice Address - Fax:469-800-7210
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0434320207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200663460AMedicaid
KS16535008Medicare PIN