Mitchell Mahan, STUDENT

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

94-11909 Issued in KS

Practice address

1121 S Clifton Ave
Wichita, KS 67218-2912

Phone

(316) 689-5500

NPI assigned

Sep 27, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1695772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720224000000",
    "number": "1366221467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 S CLIFTON AVE",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672182912",
            "telephone_number": "316-689-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 S CLIFTON AVE",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672182912",
            "telephone_number": "316-689-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHAN",
        "first_name": "MITCHELL",
        "credential": "STUDENT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-27",
        "last_updated": "2024-07-06",
        "certification_date": "2024-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "94-11909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dalton Ray Magnani, PTA
• Victoria Lynn Magnett, LMSW, LMAC
• Magnolia Medical Supply
• Nathan Z Magruder, LAC
• Rachel-Anne Magsalin
• Joshua Lee Mahannah, RN
• Ahmad Mahdi
• Khalida M Mahdi
• Mahmoud Mahdi, MD
• Jamie L Maher, MD

• Family Medicine Physician in Wichita, KS
• Providers in Wichita, KS by specialty
• Family Medicine Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.