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General NPI Number Information
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NPI Number | 1699594580
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Entity Type | Organization
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Legal Business Name | QUANTUM PEDIATRIC NEUROLOGY LLC
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 1900 W TENAFLY DR
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City | COLUMBIA
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State | MO
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Zip | 65203-8032
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Country | US
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Telephone | 573-239-8404
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Fax |
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Provider Business Mailing Address
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Address Line | 525 N KEENE ST STE 302
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City | COLUMBIA
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State | MO
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Zip | 65201-6967
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IBRAHIM BINALSHEIKH
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Credential |
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Telephone | 573-239-8404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number |
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License Number State |
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