Provider Demographics
NPI:1063448686
Name:BASHIR, AMANI ABDALLA (MBBS)
Entity Type:Individual
Prefix:
First Name:AMANI
Middle Name:ABDALLA
Last Name:BASHIR
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DRIVE
Mailing Address - Street 2:UNIVERSITY OF IOWA HOSPITALS AND CLINICS
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242
Mailing Address - Country:US
Mailing Address - Phone:319-467-5706
Mailing Address - Fax:319-356-8470
Practice Address - Street 1:200 HAWKINS DRIVE
Practice Address - Street 2:UNIVERSITY OF IOWA HOSPITALS AND CLINICS
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242
Practice Address - Country:US
Practice Address - Phone:319-467-5706
Practice Address - Fax:319-356-8470
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36528207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0725408Medicaid
IA13428OtherWELLMARK BCBS
IA13390OtherWELLMARK BCBS
IA0725408Medicaid
IAI56812Medicare UPIN
IAP00335049Medicare ID - Type UnspecifiedRAILROAD MC
IAI17936Medicare ID - Type Unspecified