Provider Demographics
NPI:1861613598
Name:AZIZ R MAKSOUD MD PA
Entity type:Organization
Organization Name:AZIZ R MAKSOUD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BENNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-712-9234
Mailing Address - Street 1:9350 E 35TH ST N
Mailing Address - Street 2:STE 101
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2019
Mailing Address - Country:US
Mailing Address - Phone:316-265-1308
Mailing Address - Fax:316-712-9286
Practice Address - Street 1:9350 E 35TH ST N
Practice Address - Street 2:STE 101
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2019
Practice Address - Country:US
Practice Address - Phone:316-265-1308
Practice Address - Fax:316-712-9286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0428027207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS111316Medicare PIN