Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | 23626 | NE |
Y | 2086S0120X | Pediatric Surgery | 23626 | NE |
N | 2086X0206X | Surgical Oncologist | 23626 | NE |
NPI | 1174697502 |
---|---|
Provider Name | Dr. Shahab F Abdessalam |
First Address | Boys Town, NE 68010 |
Second Address | Boys Town, NE 68010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2006 |
Last Update Date | 13/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0721167 | (05) | IA |
17-01116 | UHC (01) | |
250578 | MIDLANDS CHOICE (01) | |
30422 | BCBS (01) | NE |