Provider Demographics
NPI:1891789012
Name:KADRI, ABDU (MD)
Entity Type:Individual
Prefix:
First Name:ABDU
Middle Name:
Last Name:KADRI
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 1:3338 OAKWELL CT
Mailing Address - Street 2:STE. 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-3086
Mailing Address - Country:US
Mailing Address - Phone:210-946-6466
Mailing Address - Fax:210-946-0459
Practice Address - Street 1:3338 OAKWELL CT
Practice Address - Street 2:STE. 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-3086
Practice Address - Country:US
Practice Address - Phone:210-946-6466
Practice Address - Fax:210-946-0459
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0545207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122168110Medicaid
TX122168110Medicaid