Provider Demographics
NPI:1740261205
Name:AMAWI, MOHAMMAD SADI (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:SADI
Last Name:AMAWI
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 1:2020 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-1000
Mailing Address - Country:US
Mailing Address - Phone:620-227-1133
Mailing Address - Fax:620-227-1129
Practice Address - Street 1:2020 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-1000
Practice Address - Country:US
Practice Address - Phone:620-227-1133
Practice Address - Fax:620-227-1129
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0416694208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100084000AMedicaid
B68557Medicare UPIN
KS100084000AMedicaid