Provider Demographics
NPI:1265084339
Name:QASSWAL, MOHAMMED M (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:M
Last Name:QASSWAL
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 1:7710 MERCY ROAD
Mailing Address - Street 2:SUITE 202, CU DEPARTMENT OF INTERNAL MEDICINE
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2353
Mailing Address - Country:US
Mailing Address - Phone:402-280-4392
Mailing Address - Fax:
Practice Address - Street 1:7710 MERCY ROAD
Practice Address - Street 2:SUITE 202, CU DEPARTMENT OF INTERNAL MEDICINE
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2353
Practice Address - Country:US
Practice Address - Phone:402-280-4392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8489207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty