Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2019024548 | MO |
N | 111NI0900X | Internist | 2019024548 | MO |
NPI | 1003260787 |
---|---|
Provider Name | Mr. Ghulam Ghous |
First Address | Kansas City, MO 64184-3966 |
Second Address | Columbia, MO 65212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2016 |
Last Update Date | 25/07/2019 |