Healthcare Provider Details

I. General information

NPI: 1275510448
Provider Name (Legal Business Name): BABA ABUDU MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W 4TH ST
COFFEYVILLE KS
67337-3306
US

IV. Provider business mailing address

PO BOX 787
COFFEYVILLE KS
67337-0787
US

V. Phone/Fax

Practice location:
  • Phone: 620-251-1200
  • Fax:
Mailing address:
  • Phone: 316-685-8428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BABA ABUDU
Title or Position: PRESIDENT
Credential: MD
Phone: 316-685-8428