DR. YAZAN A ABDALLA (NPI# 1033365358) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033365358 |
| Entity Type | Individual |
| Full Name | DR. YAZAN A ABDALLA |
| Credential | M.D. |
| Practice Address |
10012 Kennerly Rd Suite 404 Saint Louis MO 63128-2197 |
| Mailing Address |
10012 Kennerly Rd Ste 404 Saint Louis MO 63128-2197 |
| Practice Telephone | 3145435911 |
| Practice Fax Number | 3145435914 |
| Mailing Telephone | 3145435911 |
| Mailing Fax Number | 3145435914 |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2017-03-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 2007016056 | MO | Allopathic & Osteopathic Physicians |
| Y | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
2011014220 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | MEDICARE PTAN # | 156440048 | 01 |
| Street Address |
10012 KENNERLY RD SUITE 404 |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63128-2197 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154323376 | Minxiang Gu | Internal Medicine | 10012 Kennerly Rd, Suite 100, Saint Louis, MO 63128-2197 | 2005-06-01 |
| 1154935880 | Carol Bivins | Nurse Practitioner | 10012 Kennerly Rd, Saint Louis, MO 63128-2042 | 2020-09-01 |
| 1346705993 | Melissa Kay Wallis | Nurse Practitioner | 10012 Kennerly Rd, Saint Louis, MO 63128-2042 | 2019-02-07 |
| 1255833323 | Cameron Rousseau | Physician Assistant | 10012 Kennerly Rd, Saint Louis, MO 63128-2197 | 2018-03-05 |
| 1649721192 | Brittany Shoults | Nurse Practitioner | 10012 Kennerly Rd, Saint Louis, MO 63128-2197 | 2016-10-19 |
| 1366891137 | Emily Grace Peters | Nurse Practitioner | 10012 Kennerly Rd, Suite 202, Saint Louis, MO 63128-2197 | 2016-06-12 |
| 1194171033 | Rhonda G Haag | Nurse Practitioner | 10012 Kennerly Rd, Ste 101, Saint Louis, MO 63128-2197 | 2016-05-10 |
| 1669831293 | Kate E Lee | Nurse Practitioner | 10012 Kennerly Rd, Suite 300, Saint Louis, MO 63128-2197 | 2016-02-10 |
| 1477911857 | Aaron Rippelmeyer | Nurse Practitioner | 10012 Kennerly Rd, Suite 300, Saint Louis, MO 63128-2197 | 2016-02-01 |
| 1124492483 | Lesley Maria Endermuhle | Nurse Practitioner | 10012 Kennerly Rd, Ste 305, Saint Louis, MO 63128-2197 | 2015-11-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235771155 | James T Fetsch Dmd LLC | Dentist | 10004 Kennerly Rd Suite 240, Saint Louis, MO 63128 | 2019-10-11 |
| 1326504655 | Nikodem Dental Holdings | Dentist | 4337 Butler Hill Rd Suite G, St Louis Mo, MO 63128 | 2019-02-12 |
| 1932678505 | Michelle Anne Arvidson | Physical Therapy Assistant | Elite Physical Therapy, 12608 Lamplighter Square Shopping Center, St. Louis, MO 63128 | 2018-11-13 |
| 1245726710 | Kristen Rider | Nurse Practitioner | 9964 Kennerly Rd Ste D, Saint Louis, MO 63128 | 2018-07-07 |
| 1306217427 | Sophia Bednarski | Dentist | 12660 Lamplighter Square Shopping Center, St. Louis, MO 63128 | 2015-10-15 |
| 1427434224 | Darcie Burrus | Counselor | 12523 Old Tesson Rd G, St Louis, MO 63128 | 2015-08-04 |
| 1710368584 | Sara Hawatmeh | Internal Medicine | 12345 W Bend Dr Ste 304, Saint Louis, MO 63128 | 2015-06-17 |
| 1871989590 | Celia Grace Montes-kolence | Speech-Language Pathologist | 12335 W Bend Drive, Saint Louis, MO 63128 | 2015-04-09 |
| 1245629302 | Marius Antonio Evans | Dentist | 9911 Kennerly Rd., Suite G, St. Louis, MO 63128 | 2015-01-13 |
| 1801230313 | Sarah Elizabeth Walsh | Emergency Medicine | 10010 Kennerly Road, Emergency Department, St. Anthony's Medical Center, St. Louis, MO 63128 | 2013-04-26 |
| Find all providers in zip 63128 | ||||
| Taxonomy Code | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215359484 | Advanced Gastroenterology & Colon Cancer Screening Center LLC | Internal Medicine | 763 S New Ballas Rd # 265, Saint Louis, MO 63141-8704 | 2014-01-07 |
| 1689014276 | Antonio Ricardo Cheesman Rocca | Internal Medicine | 1225 S Grand Blvd Fl 3, Saint Louis, MO 63104-1016 | 2013-06-27 |
| 1720346729 | Kayci Renee Huff-hardy | Internal Medicine | 621 S New Ballas Rd Ste 437a, Saint Louis, MO 63141-8259 | 2012-04-26 |
| 1750676664 | Parul Gor | Internal Medicine | 615 S New Ballas Rd Ste 1200, Saint Louis, MO 63141 | 2011-06-20 |
| 1902034499 | Giao Vuong | Internal Medicine | 6400 Clayton Rd Ste 216, Saint Louis, MO 63117-1850 | 2009-06-23 |
| 1790908820 | Kishore Maganty | Internal Medicine | 522 N New Ballas Rd Ste 210, Saint Louis, MO 63141-6829 | 2007-04-10 |
| 1043309792 | Robert M Mcmahon | Internal Medicine | 1610 Des Peres Rd Ste 150, Saint Louis, MO 63131-1863 | 2006-10-12 |
| 1154418119 | Hugo A Villarreal | Internal Medicine | 13276 Manchester Rd, Saint Louis, MO 63131-1706 | 2006-10-09 |
| 1952494932 | Muhammad A. Nyazee | Internal Medicine | 11155 Dunn Rd Ste 212e, Saint Louis, MO 63136-6166 | 2006-10-02 |
| 1487745360 | David J Costigan | Internal Medicine | 10007 Kennerly Rd, Saint Louis, MO 63128-2179 | 2006-09-27 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63128 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.