Provider Demographics
NPI:1114575693
Name:DUBAD, ABDULLAHI
Entity Type:Individual
Prefix:
First Name:ABDULLAHI
Middle Name:
Last Name:DUBAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2181 MORSE RD UNIT B7
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-5800
Mailing Address - Country:US
Mailing Address - Phone:614-966-0073
Mailing Address - Fax:614-573-6325
Practice Address - Street 1:2181 MORSE RD UNIT B7
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-5800
Practice Address - Country:US
Practice Address - Phone:614-966-0073
Practice Address - Fax:614-573-6325
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHUB141850172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH84-2870484Medicaid