Healthcare Provider Details

I. General information

NPI: 1902690662
Provider Name (Legal Business Name): KASEM RIFAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
COLUMBIA MO
65212-1000
US

IV. Provider business mailing address

1346 S LOUISVILLE DR
COLUMBIA MO
65203-5303
US

V. Phone/Fax

Practice location:
  • Phone: 573-884-3001
  • Fax:
Mailing address:
  • Phone: 314-387-0589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2026037396
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: