1629027479 NPI number — DR. MOHAMMED MAMDOUH AL-QASMI MD

Table of content: DR. MOHAMMED MAMDOUH AL-QASMI MD (NPI 1629027479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629027479 NPI number — DR. MOHAMMED MAMDOUH AL-QASMI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AL-QASMI
Provider First Name:
MOHAMMED
Provider Middle Name:
MAMDOUH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1629027479
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 COLUMBUS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48708-6831
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-667-3410
Provider Business Mailing Address Fax Number:
989-667-3411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 COLUMBUS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAY CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48708-6831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-667-3410
Provider Business Practice Location Address Fax Number:
989-667-3411
Provider Enumeration Date:
05/09/2006

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: 2084N0400X , with the licence number:  4301075825 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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