Provider Demographics
NPI:1003260787
Name:GHOUS, GHULAM (MD)
Entity type:Individual
Prefix:MR
First Name:GHULAM
Middle Name:
Last Name:GHOUS
Suffix:
Gender:
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:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:1125 MADISON ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-5227
Practice Address - Country:US
Practice Address - Phone:573-632-5000
Practice Address - Fax:573-634-2033
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2025-03-28
Deactivation Date:2016-12-14
Deactivation Code:
Reactivation Date:2017-01-06
Provider Licenses
StateLicense IDTaxonomies
GA103789207RH0003X
MO2019024548208M00000X, 207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine