Basic Information
Provider Information | |||||||||
NPI: | 1740299916 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WADUD | ||||||||
FirstName: | SAEED | ||||||||
MiddleName: | E | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WADUD | ||||||||
OtherFirstName: | S | ||||||||
OtherMiddleName: | ERIC | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 8035 | ||||||||
Address2: |   | ||||||||
City: | WICHITA | ||||||||
State: | KS | ||||||||
PostalCode: | 672080035 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3166899135 | ||||||||
FaxNumber: | 3166899102 | ||||||||
Practice Location | |||||||||
Address1: | 848 N SAINT FRANCIS ST STE 3901 | ||||||||
Address2: |   | ||||||||
City: | WICHITA | ||||||||
State: | KS | ||||||||
PostalCode: | 67214 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3162685000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/05/2006 | ||||||||
LastUpdateDate: | 09/11/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/11/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 29785 | KS | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 208000000X | 29785 | KS | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
ID Information
ID | Type | State | Issuer | Description | 213925 | 01 | KS | COVENTRY | OTHER | 100427600A | 05 | KS |   | MEDICAID | 100959 | 01 | KS | HPK | OTHER | 12149491 | 01 | KS | MULTIPLAN | OTHER | 103704 | 01 | KS | BCBS | OTHER | 7832 | 01 | KS | PHS | OTHER |