Provider Demographics
NPI:1609131606
Name:FAHMI ABDOU, ISLAM M (MD)
Entity Type:Individual
Prefix:
First Name:ISLAM
Middle Name:M
Last Name:FAHMI ABDOU
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 1:4951 CENTER ST STE 206
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3252
Mailing Address - Country:US
Mailing Address - Phone:402-933-7247
Mailing Address - Fax:402-933-7196
Practice Address - Street 1:4951 CENTER ST STE 206
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3252
Practice Address - Country:US
Practice Address - Phone:402-393-3724
Practice Address - Fax:402-933-7196
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-47431207V00000X, 390200000X
CAA147725207V00000X
MI4301101124390200000X
NE33280207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty