The period of the sukkalmahs was followed by the Middle Elamite period. While details of the transition between these two eras are lacking, the onset of the Middle Elamite period is usually put at c. 1500 BC, its end c. 1100 BC. Three phases have been distinguished, each marked by a different dynasty named after its founder or most significant early leader (thus the Kidinuids, Igihalkids, and Shutrukids). This is the period when the title ‘king of Susa and Anshan’, as it is expressed in Akkadian texts, or ‘king of Anshan and Susa’, according to the usage of the Elamite sources, is attested.

The first phase of this period (Middle Elamite I, c. 1500–1400 BC) is notable not only for the wealth of evidence from Susa but for the foundation of a new and important site at Haft Tepe by a king named Tepti-ahar. The second phase (Middle Elamite II, c. 1400–1200 BC) is characterized by inter-marriage with the royal family of the contemporary Kassite dynasty in Babylonia. This was also the time when one of the Middle Elamite II period's most important rulers, Untash-Napirisha, founded yet another important new site at Choga Zanbil, ancient Al Untash-Napirisha, complete with a stepped temple tower or ziggurat, where the deities of the highlands were worshipped alongside those of the lowlands. Susa, too, provides abundant evidence of occupation at this time.