Healthcare Provider Details

I. General information

NPI: 1922461342
Provider Name (Legal Business Name): OLAJIDE ABDULQADRI BUHARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2016
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 S CONROE MEDICAL DR STE 140
CONROE TX
77304-5395
US

IV. Provider business mailing address

603 S CONROE MEDICAL DR STE 140
CONROE TX
77304-5395
US

V. Phone/Fax

Practice location:
  • Phone: 936-978-0466
  • Fax: 936-978-0469
Mailing address:
  • Phone: 936-978-0466
  • Fax: 936-978-0469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberT4620
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number75907
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberT4620
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: