Healthcare Provider Details

I. General information

NPI: 1588291041
Provider Name (Legal Business Name): MUHANNAD KURTOM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 NEW BERN AVE
RALEIGH NC
27610-1247
US

IV. Provider business mailing address

PO BOX 808800
KANSAS CITY MO
64180-8800
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-5318
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2023-02034
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: