Basic Information
Provider Information | |||||||||
NPI: | 1235260464 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ABUBAKR | ||||||||
FirstName: | SAMER | ||||||||
MiddleName: | MOHAMMAD | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5450 FRANTZ RD STE 360 | ||||||||
Address2: |   | ||||||||
City: | DUBLIN | ||||||||
State: | OH | ||||||||
PostalCode: | 430164141 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6145668883 | ||||||||
FaxNumber: | 6145668149 | ||||||||
Practice Location | |||||||||
Address1: | 1000 MCKINLEY PARK DR | ||||||||
Address2: |   | ||||||||
City: | MARION | ||||||||
State: | OH | ||||||||
PostalCode: | 433026399 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6145668883 | ||||||||
FaxNumber: | 6145668149 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/08/2007 | ||||||||
LastUpdateDate: | 11/16/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/16/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 36114548 | IL | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 35.098468 | OH | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | 35.098468 | OH | Y |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
ID Information
ID | Type | State | Issuer | Description | H819490 | 01 | OH | MEDICARE OHIO | OTHER | 0088058 | 05 | OH |   | MEDICAID | 036-114548 | 01 | IL | IL MEDICAL LICENSE | OTHER |