Provider Demographics
NPI:1114065968
Name:WAFIK A ABDOU MD INC
Entity Type:Organization
Organization Name:WAFIK A ABDOU MD INC
Other - Org Name:WAFIK ABDOU MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WAFIK
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABDOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-335-7755
Mailing Address - Street 1:PO BOX 2029
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93303-2029
Mailing Address - Country:US
Mailing Address - Phone:661-335-7755
Mailing Address - Fax:665-335-7766
Practice Address - Street 1:2400 BAHAMAS DR STE 100
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0746
Practice Address - Country:US
Practice Address - Phone:661-328-2333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66371207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G663710Medicaid
CA00G663710Medicare ID - Type UnspecifiedMEDICARE NUMBER
F32123Medicare UPIN