1073968996 NPI number — MR. ABDULLAH KH A KH ALBADER M.D.

Table of content: MR. ABDULLAH KH A KH ALBADER M.D. (NPI 1073968996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073968996 NPI number — MR. ABDULLAH KH A KH ALBADER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALBADER
Provider First Name:
ABDULLAH
Provider Middle Name:
KH A KH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073968996
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/21/2016
NPI Reactivation Date:
03/21/2017

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 NW 14TH STREET
Provider Second Line Business Mailing Address:
FIFTH FLOOR
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-243-6466
Provider Business Mailing Address Fax Number:
305-243-2009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1611 NW 14TH STREET
Provider Second Line Business Practice Location Address:
FIFTH FLOOR
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-243-6466
Provider Business Practice Location Address Fax Number:
305-243-2009
Provider Enumeration Date:
04/28/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)