Provider Demographics
NPI:1083866149
Name:AL-AMOODI, MOHAMMED
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:AL-AMOODI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6875 W 51ST TER
Mailing Address - Street 2:APT. 2B
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-1558
Mailing Address - Country:US
Mailing Address - Phone:913-271-7328
Mailing Address - Fax:
Practice Address - Street 1:10506 MONTGOMERY RD STE 300A
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-4400
Practice Address - Country:US
Practice Address - Phone:513-246-2400
Practice Address - Fax:513-246-4050
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008028015207R00000X
OH35.136825207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2565399Medicaid