Healthcare Provider Details

I. General information

NPI: 1598766891
Provider Name (Legal Business Name): MA'N ADEL ABDULLAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE HOSPITAL DR
COLUMBIA MO
65212-0001
US

IV. Provider business mailing address

2101 JACKSON ST STE 101
ANDERSON IN
46016-4386
US

V. Phone/Fax

Practice location:
  • Phone: 573-884-8445
  • Fax: 573-884-5318
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number01056059A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD61212444
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01056059A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2024032799
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: