Provider Demographics
NPI:1275510448
Name:BABA ABUDU MD PA
Entity Type:Organization
Organization Name:BABA ABUDU MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BABA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUDU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-685-8428
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-0787
Mailing Address - Country:US
Mailing Address - Phone:316-685-8428
Mailing Address - Fax:
Practice Address - Street 1:1400 W 4TH ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-3306
Practice Address - Country:US
Practice Address - Phone:620-251-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110535OtherBCBS
CH3542OtherRAILROAD MEDICARE
KS110535OtherBCBS
CH3542OtherRAILROAD MEDICARE