Provider Demographics
NPI:1255328738
Name:AL-MUBASLAT, AHMAD (MD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:AL-MUBASLAT
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 1:1000 CARONDELET DR
Mailing Address - Street 2:PROVIDER ENROLLMENT/ MEDICAL STAFF OFFICE
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114
Mailing Address - Country:US
Mailing Address - Phone:816-943-5744
Mailing Address - Fax:
Practice Address - Street 1:901 HEARTLAND RD STE 4810
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-6202
Practice Address - Country:US
Practice Address - Phone:816-271-1343
Practice Address - Fax:816-271-1321
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC27767207R00000X
MO2009036449207R00000X, 207RE0101X
KY41721207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1255328738Medicaid
H95874Medicare UPIN
MO1255328738Medicaid
MOP00827071Medicare PIN
SCH958741625Medicare ID - Type Unspecified