Provider Demographics
NPI:1861406258
Name:ABOUL-MAGD, AHMED SAMEH (MD)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:SAMEH
Last Name:ABOUL-MAGD
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 1:522 W 32ND ST STE 1
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-2533
Mailing Address - Country:US
Mailing Address - Phone:417-782-5000
Mailing Address - Fax:417-782-2945
Practice Address - Street 1:522 W 32ND ST STE 1
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-2533
Practice Address - Country:US
Practice Address - Phone:417-782-5000
Practice Address - Fax:417-782-2945
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-30664207RN0300X
MO113795207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK050604077001OtherBLUE CROSS BLUE SHIELD
KS200264410CMedicaid
OK200039110AMedicaid
MO203842620Medicaid
KS0000104082OtherBLUE CROSS BLUE SHIELD
MO184825OtherBLUE CROSS BLUE SHIELD
G66535Medicare UPIN
OK200039110AMedicaid
OK050604077001OtherBLUE CROSS BLUE SHIELD
MO909234325Medicare ID - Type Unspecified