Provider Demographics
NPI:1427067230
Name:SABA, TABASSUM (MBBS)
Entity type:Individual
Prefix:
First Name:TABASSUM
Middle Name:
Last Name:SABA
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2526
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-2526
Mailing Address - Country:US
Mailing Address - Phone:417-347-7600
Mailing Address - Fax:417-347-7608
Practice Address - Street 1:932 E 34TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3932
Practice Address - Country:US
Practice Address - Phone:417-347-7600
Practice Address - Fax:417-347-7608
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010265872084N0400X, 2084P0800X
KS04293332084N0400X
MN713772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100426590BMedicaid
OK100850130AMedicaid
MO228746563OtherBNDD
MO205877707Medicaid
MO228746563OtherBNDD
OK100850130AMedicaid
MOH65166Medicare UPIN