Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | 35336 | OK |
N | 2086S0102X | Surgical Critical Care | 63355 | TN |
Y | 2086S0120X | Pediatric Surgery | 2020010606 | MO |
NPI | 1366599185 |
---|---|
Provider Name | Ahmed Marwan |
First Address | Kansas City, MO 64184-3966 |
Second Address | Columbia, MO 65201-6626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 21/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R9566 | (05) | AL |