The Middle Elamite period begains with the rise of the Anshanite dynasties around 1500 BCE.

Their rule is characterized by an "Elamization" of Susa, and the kings take the title "king of Anshan and Susa".

While the first of these dynasties, the Kidinuids, continues to use the Akkadian language frequently in their inscriptions, the succeeding Igihalkids and Shutrukids use Elamite with increasing regularity.

Likewise, Elamite language and culture grows in importance in Susiana.

The Kidinuids (c. 1500–1400 BCE), a group of five rulers of uncertain affiliation, are identified by their use of the older title, "king of Susa and of Anshan", and by calling themselves "servant of Kirwashir", an Elamite deity, thereby introducing the pantheon of the highlands to Susiana.Of the Igehalkids (c. 1400–1210 BCE), ten rulers are known, and there are possibly more.

Some of them marry Kassite princesses.

The Kassite king of Babylon Kurigalzu II temporarily occupies Elam c. 1320 BCE, and later (c. 1230) another Kassite king, Kashtiliash IV, fighst Elam unsuccessfully.

Kiddin-Khutran I of Elam repulses the Kassites by defeating Enlil-nadin-shumi in 1224 and Adad-shuma-iddina around 1222–1217.

Under the Igehalkids, Akkadian inscriptions are rare, and Elamite highland gods become firmly established in Susa.Under the Shutrukids (c. 1210–1100 BCE), the Elamite empire reaches the height of its power.

Shutruk-Nakhkhunte and his three sons, Kutir-Nakhkhunte II, Shilhak-In-Shushinak, and Khutelutush-In-Shushinak are capable of frequent military campaigns into Kassite Babylonia, and at the same time are exhibiting vigorous construction activity—building and restoring luxurious temples in Susa and across their Empire.

Shutruk-Nakhkhunte raids Babylonia, carrying home to Susa trophies like the statues of Marduk and Manishtushu, the Manishtushu Obelisk, the Stele of Hammurabi and the stele of Naram-Sin.

In 1158 BCE, Shutruk-Nakhkhunte defeats the Kassites permanently, killing the Kassite king of Babylon, Zababa-shuma-iddin, and replacing him with his eldest son, Kutir-Nakhkhunte, who holds it no more than three years.