Basic Information
Provider Information
NPI: 1285879775
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ABU BAKR
FirstName: BAHAA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: DEPT CH 14389
Address2:  
City: PALATINE
State: IL
PostalCode: 600554389
CountryCode: US
TelephoneNumber: 7852955307
FaxNumber: 7852707646
Practice Location
Address1: 6730 SW 29TH ST
Address2:  
City: TOPEKA
State: KS
PostalCode: 666145650
CountryCode: US
TelephoneNumber: 7852722240
FaxNumber: 7852722346
Other Information
ProviderEnumerationDate: 12/11/2008
LastUpdateDate: 06/30/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RE0101X0434866KSY Allopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism

No ID Information.


Home