Provider Demographics
NPI:1598078784
Name:ABOU-ISMAIL, ANAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ANAS
Middle Name:
Last Name:ABOU-ISMAIL
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 1:1100 N PALM CANYON DR STE 211
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4426
Mailing Address - Country:US
Mailing Address - Phone:760-323-1155
Mailing Address - Fax:760-532-5486
Practice Address - Street 1:1100 N PALM CANYON DR STE 211
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4426
Practice Address - Country:US
Practice Address - Phone:760-323-1155
Practice Address - Fax:760-532-5486
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD176688207RN0300X
CAA162151207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORS00707643Medicaid