Healthcare Provider Details

I. General information

NPI: 1407425416
Provider Name (Legal Business Name): MOHAMMED QUSSAY ALI AL-SABBAGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date: 12/13/2022
Reactivation Date: 12/20/2022

III. Provider practice location address

4921 PARKVIEW PL
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

660 S EUCLID AVE CAMPUS BOX 8111
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-7382
  • Fax: 314-747-3342
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2025002975
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: