Healthcare Provider Details

I. General information

NPI: 1154426476
Provider Name (Legal Business Name): MUDATHIRU BUHARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4129 W KENNEDY BLVD STE 2
TAMPA FL
33609-2254
US

IV. Provider business mailing address

2410 NORTHSIDE DR
CLEARWATER FL
33761-2236
US

V. Phone/Fax

Practice location:
  • Phone: 135-411-4668
  • Fax: 888-249-3323
Mailing address:
  • Phone: 727-499-0351
  • Fax: 727-223-4159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME111588
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: