Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 04-36484 | KS |
N | 111NI0900X | Internist | 04-36484 | KS |
Y | 207RC0000X | Internist - Cardiovascular Disease | 04-36484 | KS |
NPI | 1003160987 |
---|---|
Provider Name | Ahmad Qaddour |
First Address | Wichita, KS 67226-2182 |
Second Address | Wichita, KS 67226-2182 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2012 |
Last Update Date | 02/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201103480A | (05) | KS |