Healthcare Provider Details

I. General information

NPI: 1861521940
Provider Name (Legal Business Name): ABDULLAHI ISA MUBARAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MARK HUNTER THOMAS M.D.

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6310 N MAIN ST
DAYTON OH
45415-3155
US

IV. Provider business mailing address

6310 N MAIN ST
DAYTON OH
45415-3155
US

V. Phone/Fax

Practice location:
  • Phone: 937-701-0030
  • Fax: 937-221-9268
Mailing address:
  • Phone: 937-701-0030
  • Fax: 937-221-9268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number35051593
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: