1891288338 NPI number — FADDY IMAD KHAMIS MD

Table of content: FADDY IMAD KHAMIS MD (NPI 1891288338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891288338 NPI number — FADDY IMAD KHAMIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHAMIS
Provider First Name:
FADDY
Provider Middle Name:
IMAD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KHAMIS
Provider Other First Name:
FADDY
Provider Other Middle Name:
IMAD
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1891288338
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20805 W 151ST ST STE 224
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLATHE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66061-7249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-355-8400
Provider Business Mailing Address Fax Number:
913-782-1574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20805 W 151ST ST STE 224
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLATHE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66061-7249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-355-8400
Provider Business Practice Location Address Fax Number:
913-782-1574
Provider Enumeration Date:
06/10/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  04-45075 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)