Provider Demographics
NPI:1083681183
Name:AL-KABBANI, SAMIR (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:
Last Name:AL-KABBANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 EXECUTIVE PARK DR
Mailing Address - Street 2:A207
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4685
Mailing Address - Country:US
Mailing Address - Phone:865-531-9430
Mailing Address - Fax:865-531-9580
Practice Address - Street 1:9000 EXECUTIVE PARK DR
Practice Address - Street 2:A207
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4685
Practice Address - Country:US
Practice Address - Phone:865-531-9430
Practice Address - Fax:865-531-9580
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0178752084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3032815Medicare ID - Type Unspecified
TNA99644Medicare UPIN