Basic Information
| Provider Information | |||||||||
| NPI: | 1821607136 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABDALLA | ||||||||
| FirstName: | KHALID | ||||||||
| MiddleName: | ABDULLATIF SADEQ | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY OF MISSOURI - KANSAS CITY SCHOOL OF MEDICINE | ||||||||
| Address2: | 2411 HOLMS, M2-301, GRADUATE MEDICAL EDUCATION | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162356627 | ||||||||
| FaxNumber: | 8162356629 | ||||||||
| Practice Location | |||||||||
| Address1: | TRUMAN MEDICAL CENTER | ||||||||
| Address2: | 2301 HOLMES ST., DEPT. OF INTERNAL MEDICINE | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164040957 | ||||||||
| FaxNumber: | 8164040003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2020 | ||||||||
| LastUpdateDate: | 09/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 20200165508 | MO | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 2020016508 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.