Provider Demographics
NPI:1558442210
Name:EL-NABBOUT, BASSEM H (MD)
Entity type:Individual
Prefix:
First Name:BASSEM
Middle Name:H
Last Name:EL-NABBOUT
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:PO BOX 8035
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-0035
Mailing Address - Country:US
Mailing Address - Phone:316-689-9135
Mailing Address - Fax:316-689-9667
Practice Address - Street 1:848 N SAINT FRANCIS ST
Practice Address - Street 2:STE. 3949
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3800
Practice Address - Country:US
Practice Address - Phone:316-268-8040
Practice Address - Fax:316-291-4880
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-339782084N0402X, 208000000X
ARE-43212084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200355820HMedicaid
003719217OtherMEDICARE
I31607Medicare UPIN
KSKA1517001Medicare PIN