Healthcare Provider Details

I. General information

NPI: 1942087457
Provider Name (Legal Business Name): ABDALLA ELTAYEB ABDALLA ABDELKADER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

4037 NW 86TH TER
GAINESVILLE FL
32606-9281
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0820
  • Fax: 352-265-0823
Mailing address:
  • Phone: 352-265-0820
  • Fax: 352-265-0823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number11023280A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMFC1952
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMFC1952
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: