Provider Demographics
NPI:1780677948
Name:KHALIFA, AMMAR (MD)
Entity type:Individual
Prefix:DR
First Name:AMMAR
Middle Name:
Last Name:KHALIFA
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 1:11661 COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-4107
Mailing Address - Country:US
Mailing Address - Phone:913-432-8400
Mailing Address - Fax:913-432-8402
Practice Address - Street 1:11661 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-4107
Practice Address - Country:US
Practice Address - Phone:913-432-8400
Practice Address - Fax:913-432-8402
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2018-10-30
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-10
Provider Licenses
StateLicense IDTaxonomies
KS04-29215207R00000X
MO2001012049207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS463966OtherFAMILY HEALTH PARTNERS
KS100458250AMedicaid
MO205803018Medicaid
32534031OtherBLUE SHIELD KANSAS CITY
KS522490OtherFIRST GUARD PROVIDER NO
KSP00047926Medicare PIN
32534031OtherBLUE SHIELD KANSAS CITY
KS463966OtherFAMILY HEALTH PARTNERS