Healthcare Provider Details

I. General information

NPI: 1700451697
Provider Name (Legal Business Name): AMENAH AL-JUBOORI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 MAPLECREST RD STE 10
BETTENDORF IA
52722-2799
US

IV. Provider business mailing address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

V. Phone/Fax

Practice location:
  • Phone: 563-421-4620
  • Fax: 563-421-4625
Mailing address:
  • Phone: 410-328-8667
  • Fax: 443-552-2991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD-55550
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: