Provider Demographics
NPI:1770543183
Name:IDBEIS, BADR (MD)
Entity type:Individual
Prefix:DR
First Name:BADR
Middle Name:
Last Name:IDBEIS
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 1:2237 KEYSTONE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002
Mailing Address - Country:US
Mailing Address - Phone:316-616-6272
Mailing Address - Fax:316-616-0407
Practice Address - Street 1:2237 KEYSTONE CIRCLE
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002
Practice Address - Country:US
Practice Address - Phone:316-616-6272
Practice Address - Fax:316-616-0407
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0418868208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100083550BMedicaid
KS100083550CMedicaid
KS100083550CMedicaid
KSB68368Medicare UPIN