Provider Demographics
NPI:1366028318
Name:ABUKAR, MUHIDIN
Entity Type:Individual
Prefix:
First Name:MUHIDIN
Middle Name:
Last Name:ABUKAR
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 1:1226 ROCKRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-7350
Mailing Address - Country:US
Mailing Address - Phone:224-601-4245
Mailing Address - Fax:
Practice Address - Street 1:1226 ROCKRIDGE PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-7350
Practice Address - Country:US
Practice Address - Phone:224-601-4245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-21
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL134641367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered