Individual
DR. SAMER IBRAHIM ANTONIOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3311 E MURDOCK ST, WICHITA, KS 67208-3054
(316) 268-5000
(316) 291-7897
Mailing address
PO BOX 8035, WICHITA, KS 67208-0035
(316) 689-9135
(316) 689-9667
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
04-32961
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003719108
MEDICARE
—
05
—
200555740D
—
KS
Enumeration date
04/17/2007
Last updated
01/25/2015
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