Healthcare Provider Details

I. General information

NPI: 1699594580
Provider Name (Legal Business Name): QUANTUM PEDIATRIC NEUROLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W TENAFLY DR
COLUMBIA MO
65203-8032
US

IV. Provider business mailing address

525 N KEENE ST STE 302
COLUMBIA MO
65201-6967
US

V. Phone/Fax

Practice location:
  • Phone: 573-239-8404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State

VIII. Authorized Official

Name: IBRAHIM BINALSHEIKH
Title or Position: OWNER
Credential:
Phone: 573-239-8404