Provider Demographics
NPI:1861413015
Name:WADUD, ABDUL (MD)
Entity type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:
Last Name:WADUD
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 1:1543 S HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-4018
Mailing Address - Country:US
Mailing Address - Phone:316-682-6814
Mailing Address - Fax:316-682-0110
Practice Address - Street 1:1543 S HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-4018
Practice Address - Country:US
Practice Address - Phone:316-682-6814
Practice Address - Fax:316-682-0110
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS-04-160212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS48-0859151OtherFEDERAL ID NUMBER
KS100083140AMedicaid
KS100083140AMedicaid
KS100083140AMedicaid