Provider Demographics
NPI:1144287574
Name:FARHOUD, HUSSAM (MD)
Entity type:Individual
Prefix:DR
First Name:HUSSAM
Middle Name:
Last Name:FARHOUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MOHAMED
Other - Middle Name:HUSSAM
Other - Last Name:FARHOUD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3535 N WEBB RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-8127
Mailing Address - Country:US
Mailing Address - Phone:316-686-5300
Mailing Address - Fax:316-651-2660
Practice Address - Street 1:3535 N WEBB RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-8127
Practice Address - Country:US
Practice Address - Phone:316-686-5300
Practice Address - Fax:316-651-2660
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-27437207R00000X, 207RC0000X, 207UN0901X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100189770AMedicaid
KS100121680OMedicaid
KSP01168074OtherRAILROAD MEDICARE
KS100325150NMedicaid
KS100325150AMedicaid