Provider Demographics
NPI:1881603421
Name:FERGUSON, HEBA SAFWAT BISHARA (MD)
Entity type:Individual
Prefix:
First Name:HEBA
Middle Name:SAFWAT BISHARA
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEBA
Other - Middle Name:SAFWAT
Other - Last Name:BISHARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:212 S TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1432
Mailing Address - Country:US
Mailing Address - Phone:316-689-5121
Mailing Address - Fax:316-689-5122
Practice Address - Street 1:7107 S MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:HAYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:67060-7678
Practice Address - Country:US
Practice Address - Phone:316-789-1174
Practice Address - Fax:316-858-4169
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-28257207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200002310AMedicaid
KS100396570BMedicaid
KSP00368414OtherMEDICARE RAILROAD
KS103347OtherBC/BS
KS100396570BMedicaid
KSP00368414OtherMEDICARE RAILROAD
KS200002310AMedicaid