Provider Demographics
NPI:1457445769
Name:ADEM, MUKHTAR (MD)
Entity Type:Individual
Prefix:DR
First Name:MUKHTAR
Middle Name:
Last Name:ADEM
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 1:101 MANNING DR
Mailing Address - Street 2:CB#7085
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7085
Mailing Address - Country:US
Mailing Address - Phone:984-974-1931
Mailing Address - Fax:984-974-2216
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:CB#7085
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7085
Practice Address - Country:US
Practice Address - Phone:984-974-1931
Practice Address - Fax:984-974-2216
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101235701207R00000X
NC200800038208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010051053Medicaid
VA010051053Medicaid
003309M84Medicare ID - Type Unspecified