Provider Demographics
NPI:1215410691
Name:ALSAADI, ESTABRAQ A
Entity Type:Individual
Prefix:
First Name:ESTABRAQ
Middle Name:A
Last Name:ALSAADI
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 1:3511 KARIKAL DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-4024
Mailing Address - Country:US
Mailing Address - Phone:614-943-9483
Mailing Address - Fax:
Practice Address - Street 1:3511 KARIKAL DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-4024
Practice Address - Country:US
Practice Address - Phone:614-943-9483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0246070Medicaid