Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 2016023492 | MO |
Y | 111NI0900X | Internist | 2016023492 | MO |
NPI | 1003268665 |
---|---|
Provider Name | Omar Khaled Mahmoud Abughanimeh |
First Address | Kansas City, MO 64108-2640 |
Second Address | Kansas City, MO 64108-2640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2016 |
Last Update Date | 13/08/2016 |