Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 036.135831 | IL |
N | 2080P0202X | Pediatric Cardiologist | 036.135831 | IL |
Y | 2080P0202X | Pediatric Cardiologist | R2518 | TX |
NPI | 1154617355 |
---|---|
Provider Name | Maytham Abed Al-Kubaisi |
First Address | Colleyville, TX 76034-1477 |
Second Address | Dallas, TX 75230-2571 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2011 |
Last Update Date | 01/03/2021 |