1124525597 NPI number — AHMED KASSEM SELIM ABDALLAH M.D

Table of content: AHMED KASSEM SELIM ABDALLAH M.D (NPI 1124525597)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124525597 NPI number — AHMED KASSEM SELIM ABDALLAH M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABDALLAH
Provider First Name:
AHMED
Provider Middle Name:
KASSEM SELIM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124525597
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
11/28/2018
NPI Reactivation Date:
12/05/2018

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5301 SOUTH CONGRESS AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTIS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-548-1273
Provider Business Mailing Address Fax Number:
561-548-1572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 JFK DRIVE
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
ATLANTIS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-548-1450
Provider Business Practice Location Address Fax Number:
561-548-1459
Provider Enumeration Date:
04/11/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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