Provider Demographics
NPI:1891778221
Name:JAMOUS, ABDULSALAM (MD)
Entity Type:Individual
Prefix:
First Name:ABDULSALAM
Middle Name:
Last Name:JAMOUS
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 1:4600 MEMORIAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5363
Mailing Address - Country:US
Mailing Address - Phone:618-233-2220
Mailing Address - Fax:
Practice Address - Street 1:4600 MEMORIAL DR STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5363
Practice Address - Country:US
Practice Address - Phone:618-233-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-31034207RP1001X
IL036121797207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036121797Medicaid
IL036121797Medicaid
I30147Medicare UPIN