Provider Demographics
NPI:1306057310
Name:ABBAS, MOHAMMED ALI (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:ALI
Last Name:ABBAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1011 BOWLES AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-2384
Mailing Address - Country:US
Mailing Address - Phone:636-681-3030
Mailing Address - Fax:636-326-1545
Practice Address - Street 1:1011 BOWLES AVE STE 220
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2384
Practice Address - Country:US
Practice Address - Phone:636-681-3030
Practice Address - Fax:636-326-1545
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2023-12-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO20060169182085R0202X
MO20070220422085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology