Healthcare Provider Details

I. General information

NPI: 1902467897
Provider Name (Legal Business Name): EHAB ABDALLAH EMBABY ABDELGYED M.B.B.CH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2019
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MERCY WAY STE 420
JOPLIN MO
64804-4524
US

IV. Provider business mailing address

100 MERCY WAY STE 420
JOPLIN MO
64804-4524
US

V. Phone/Fax

Practice location:
  • Phone: 417-556-3130
  • Fax: 417-556-3131
Mailing address:
  • Phone: 417-556-3130
  • Fax: 417-556-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number64116
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number04-49471
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2023044753
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number57.252146
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: