Provider Demographics
NPI:1861410706
Name:ABDELJALIL, ASEM A (MD)
Entity type:Individual
Prefix:
First Name:ASEM
Middle Name:A
Last Name:ABDELJALIL
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 1:2310 HOLMES ST STE 800
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2602
Mailing Address - Country:US
Mailing Address - Phone:816-218-2500
Mailing Address - Fax:
Practice Address - Street 1:2301 HOLMES ST
Practice Address - Street 2:DEPARTMENT OF MEDICINE
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2640
Practice Address - Country:US
Practice Address - Phone:816-404-5001
Practice Address - Fax:816-404-5014
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012025620207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200845250Medicaid
MO1861410706Medicaid
INP00394437OtherRAILROAD MEDICARE
IN677700RMedicare PIN
SCAA33132277Medicare PIN
219070DMedicare PIN