1881610491 NPI number — HUSAM A BARAKAT M. D.

Table of content: HUSAM A BARAKAT M. D. (NPI 1881610491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881610491 NPI number — HUSAM A BARAKAT M. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARAKAT
Provider First Name:
HUSAM
Provider Middle Name:
A
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:
1881610491
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1115 ALASKA ST STE 214
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST PLAINS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65775-2014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-257-5834
Provider Business Mailing Address Fax Number:
417-257-5835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1115 ALASKA ST STE 214
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PLAINS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65775-2014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-257-5834
Provider Business Practice Location Address Fax Number:
417-257-5835
Provider Enumeration Date:
07/15/2006

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: 207RG0100X , with the licence number:  117786 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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