Healthcare Provider Details

I. General information

NPI: 1225444862
Provider Name (Legal Business Name): BARAKAT KH. M.B ABURAJAB ALTAMIMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MERCY GASTROENTEROLOGY CLINIC 788 8TH AVENUE SE ; SUITE 300
CEDAR RAPIDS IA
52401
US

IV. Provider business mailing address

MERCY GASTROENTEROLOGY CLINIC 788 8TH AVENUE SE ; SUITE 300
CEDAR RAPIDS IA
52401
US

V. Phone/Fax

Practice location:
  • Phone: 319-369-4542
  • Fax: 319-369-4543
Mailing address:
  • Phone: 319-369-4542
  • Fax: 319-369-4543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD-46741
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: