Provider Demographics
NPI:1356451785
Name:ABUDAYYEH, ISLAM (MD)
Entity Type:Individual
Prefix:
First Name:ISLAM
Middle Name:
Last Name:ABUDAYYEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LOMA LINDA UNIVERSITY
Mailing Address - Street 2:11234 ANDERSON STREET, ROOM 4404
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2741
Mailing Address - Country:US
Mailing Address - Phone:909-558-4200
Mailing Address - Fax:
Practice Address - Street 1:LOMA LINDA UNIVERSITY
Practice Address - Street 2:11234 ANDERSON STREET, ROOM 4404
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2741
Practice Address - Country:US
Practice Address - Phone:909-558-9730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84032207RI0011X, 207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ137050Medicaid
AZAZ0918200OtherBCBS
AZ111367Medicare ID - Type UnspecifiedMARICOPA
AZ137050Medicaid
AZ111366Medicare ID - Type UnspecifiedPINAL