Provider Demographics
NPI:1124525597
Name:ABDALLAH, AHMED KASSEM SELIM (MD)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:KASSEM SELIM
Last Name:ABDALLAH
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 1:5301 SOUTH CONGRESS AVENUE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462
Mailing Address - Country:US
Mailing Address - Phone:561-548-1273
Mailing Address - Fax:561-548-1572
Practice Address - Street 1:180 JFK DRIVE
Practice Address - Street 2:SUITE 210
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462
Practice Address - Country:US
Practice Address - Phone:561-548-1450
Practice Address - Fax:561-548-1459
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-12-05
Deactivation Date:2018-11-28
Deactivation Code:
Reactivation Date:2018-12-05
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program