Provider Demographics
NPI:1811199912
Name:ABDU, EMUN (MD)
Entity Type:Individual
Prefix:DR
First Name:EMUN
Middle Name:
Last Name:ABDU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 E HIGHLAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4740
Mailing Address - Country:US
Mailing Address - Phone:480-372-2113
Mailing Address - Fax:480-372-2114
Practice Address - Street 1:2122 E HIGHLAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4740
Practice Address - Country:US
Practice Address - Phone:480-372-2113
Practice Address - Fax:480-372-2114
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD60213906207T00000X
AZFA2645147207T00000X
ORLL16239390200000X
AZ47060207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG8903367Medicare PIN