=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154426476
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MUDATHIRU BUHARI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2006
-----------------------------------------------------
Last Update Date | 10/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4129 W KENNEDY BLVD STE 2
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33609-2254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 135-411-4668
-----------------------------------------------------
Fax | 888-249-3323
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2410 NORTHSIDE DR
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33761-2236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-499-0351
-----------------------------------------------------
Fax | 727-223-4159
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number | ME111588
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------