Provider Demographics
NPI:1316996994
Name:MADI, AHMED M (MD)
Entity type:Individual
Prefix:DR
First Name:AHMED
Middle Name:M
Last Name:MADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:25123 W 105TH TER
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7654
Mailing Address - Country:US
Mailing Address - Phone:913-787-3063
Mailing Address - Fax:913-839-3303
Practice Address - Street 1:3500 S 4TH ST FL 1
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5043
Practice Address - Country:US
Practice Address - Phone:913-787-3063
Practice Address - Fax:913-839-3303
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2006009459207R00000X
KS04-31637207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2006009459OtherSTATE LICENSE
MO200993400Medicaid
36870019OtherBLUE SHIELD KANSAS CITY
KS200386970AMedicaid
KS31637OtherSTATE LICENSE
MO200993400Medicaid
KS200386970AMedicaid
36870019OtherBLUE SHIELD KANSAS CITY