Provider Demographics
NPI:1881383586
Name:ABDELKAFI, BUHISA
Entity type:Individual
Prefix:
First Name:BUHISA
Middle Name:
Last Name:ABDELKAFI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W WASHINGTON ST APT 3710
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-3519
Mailing Address - Country:US
Mailing Address - Phone:512-888-7598
Mailing Address - Fax:
Practice Address - Street 1:5201 WASHINGTON AVE STE A
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4242
Practice Address - Country:US
Practice Address - Phone:262-634-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL019.034255122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program