Provider Demographics
NPI:1295721678
Name:ABUELSHAR, ADDI S (MD)
Entity type:Individual
Prefix:
First Name:ADDI
Middle Name:S
Last Name:ABUELSHAR
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 1:1200 E PECAN
Mailing Address - Street 2:JCMH/ HOSPITALIST OFFICE
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521
Mailing Address - Country:US
Mailing Address - Phone:580-379-5992
Mailing Address - Fax:580-379-5999
Practice Address - Street 1:1200 E PECAN
Practice Address - Street 2:JCMH/ HOSPITALIST OFFICE
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521
Practice Address - Country:US
Practice Address - Phone:580-379-5992
Practice Address - Fax:580-379-5999
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK20057207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10225280AMedicaid
OK10225280AMedicaid
OK080183052OtherRAILROAD MEDICARE
G53755Medicare UPIN
OK682427054Medicare ID - Type Unspecified