Healthcare Provider Details

I. General information

NPI: 1558442210
Provider Name (Legal Business Name): BASSEM H EL-NABBOUT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 N SAINT FRANCIS ST STE. 3949
WICHITA KS
67214-3800
US

IV. Provider business mailing address

PO BOX 8035
WICHITA KS
67208-0035
US

V. Phone/Fax

Practice location:
  • Phone: 316-268-8040
  • Fax: 316-291-4880
Mailing address:
  • Phone: 316-689-9135
  • Fax: 316-689-9667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-33978
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number04-33978
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberE-4321
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: