Organization
KANSAS PEDIATRIC NEUROLOGY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BASSEM EL-NABBOUT MD (DIRECT OWNER)
(316) 253-8090
Entity
Organization
Contact information
Practice address
10111 E 21ST ST N STE 405, WICHITA, KS 67206-3508
(316) 796-5610
(316) 796-5611
Mailing address
10111 E 21ST ST N STE 405, WICHITA, KS 67206-3508
(316) 796-5610
(316) 796-5611
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
KS
Enumeration date
05/24/2019
Last updated
05/24/2019
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