=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386741676
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AHMAD BASHAR ABDULKARIM MD, PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 03/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1030 JEFFERSON AVE
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38104-2127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-521-8990
-----------------------------------------------------
Fax | 901-577-7367
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 965 RIDGE LAKE BLVD STE 103
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38120-9446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-227-3255
-----------------------------------------------------
Fax | 901-227-8591
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 36429
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------