Provider Demographics
NPI:1518753037
Name:ABU-ALKEBASH, MAHMOUD NOFAL ATTALAH
Entity type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:NOFAL ATTALAH
Last Name:ABU-ALKEBASH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 SOUTH JACKSON ST
Mailing Address - Street 2:1ST FLOOR, AMBULATORY CARE BUILDING- ATT:TAMMY THOMPSON
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-852-8605
Mailing Address - Fax:
Practice Address - Street 1:550 SOUTH JACKSON ST
Practice Address - Street 2:1ST FLOOR, AMBULATORY CARE BUILDING- ATT:TAMMY THOMPSON
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-852-8605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program