Provider Demographics
NPI:1639372766
Name:YACOUB, ABDULRAHEEM (MD)
Entity type:Individual
Prefix:
First Name:ABDULRAHEEM
Middle Name:
Last Name:YACOUB
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 1:2330 SHAWNEE MISSION PARKWAY
Mailing Address - Street 2:SUITE 210, MS 5003
Mailing Address - City:WESTWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66205
Mailing Address - Country:US
Mailing Address - Phone:913-588-6029
Mailing Address - Fax:
Practice Address - Street 1:2330 SHAWNEE MISSION PARKWAY
Practice Address - Street 2:SUITE 210, MS 5003
Practice Address - City:WESTWOOD
Practice Address - State:KS
Practice Address - Zip Code:66205
Practice Address - Country:US
Practice Address - Phone:913-588-6029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005020355390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program