Healthcare Provider Details

I. General information

NPI: 1508433509
Provider Name (Legal Business Name): IBRAHIM ABUALNADI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 FAR WEST DR STE 201
SAINT JOSEPH MO
64506-3514
US

IV. Provider business mailing address

105 FAR WEST DR STE 201
SAINT JOSEPH MO
64506-3514
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-8182
  • Fax: 816-271-8183
Mailing address:
  • Phone: 816-271-8182
  • Fax: 816-271-8183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2025051210
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: