Provider Demographics
NPI:1407425416
Name:AL-SABBAGH, MOHAMMED QUSSAY ALI (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:QUSSAY ALI
Last Name:AL-SABBAGH
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 1:3901, RAINBOW BLVD, UNIVERSITY OF KANSAS MEDICAL CENTER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-917-9031
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF KANSAS MEDICAL CENTER 3901 RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-1485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2022-12-20
Deactivation Date:2022-12-13
Deactivation Code:
Reactivation Date:2022-12-20
Provider Licenses
StateLicense IDTaxonomies
390200000X
KS94-106892084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program