Provider Demographics
NPI:1154617355
Name:AL-KUBAISI, MAYTHAM ABED (MD)
Entity type:Individual
Prefix:
First Name:MAYTHAM
Middle Name:ABED
Last Name:AL-KUBAISI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MAYTHAM
Other - Middle Name:ABED
Other - Last Name:SRAYYIH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4432 LAFITE LN
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-1477
Mailing Address - Country:US
Mailing Address - Phone:682-554-5581
Mailing Address - Fax:
Practice Address - Street 1:7777 FOREST LN BLDG D
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2571
Practice Address - Country:US
Practice Address - Phone:972-566-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-26
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.135831208000000X, 2080P0202X
TXR25182080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics