Basic Information
| Provider Information | |||||||||
| NPI: | 1376504985 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURIDI | ||||||||
| FirstName: | ABDUL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 716 W BROADWAY | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402022216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022389911 | ||||||||
| FaxNumber: | 5022389912 | ||||||||
| Practice Location | |||||||||
| Address1: | 716 W BROADWAY | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402022216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025957744 | ||||||||
| FaxNumber: | 5025957007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 09/08/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 33344 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 01045734A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207R00000X | 33344 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00013440 | 01 | RAILROAD MEDICARE | OTHER | 64028079 | 05 | KY | MEDICAID | 200127760 | 05 | IN | MEDICAID |