Provider Demographics
NPI:1861485104
Name:KABOUR, AMEER (MD)
Entity Type:Individual
Prefix:
First Name:AMEER
Middle Name:
Last Name:KABOUR
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 1:3 NEENAH CTR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3070
Mailing Address - Country:US
Mailing Address - Phone:920-731-8900
Mailing Address - Fax:920-738-5369
Practice Address - Street 1:1818 N MEADE ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-3454
Practice Address - Country:US
Practice Address - Phone:920-731-8900
Practice Address - Fax:920-738-5369
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071058207RC0000X
WI82764207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH02291OtherPARAMOUNT
MI4127151Medicaid
OH060055319OtherRAILROAD MEDICARE
OH0310792Medicaid
OH000000140672OtherANTHEM
MI1105810651OtherBLUE CROSS BLUE SHIELD MICHIGAN
MI4127151Medicaid
OH$$$$$$$$$005OtherMMO
MI1105810651OtherBLUE CROSS BLUE SHIELD MICHIGAN
OH0310792Medicaid