Provider Demographics
NPI:1699141747
Name:TAN ABDULLAH, AMIRAH BINTI (MD)
Entity type:Individual
Prefix:
First Name:AMIRAH
Middle Name:BINTI
Last Name:TAN ABDULLAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMIRAH
Other - Middle Name:B
Other - Last Name:ABDULLAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:102 OZARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:MO
Mailing Address - Zip Code:65453-1664
Mailing Address - Country:US
Mailing Address - Phone:573-885-6600
Mailing Address - Fax:573-885-6610
Practice Address - Street 1:102 OZARK DR STE B
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:MO
Practice Address - Zip Code:65453-1664
Practice Address - Country:US
Practice Address - Phone:573-885-6600
Practice Address - Fax:573-885-6610
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019024482207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology