Provider Demographics
NPI:1063886810
Name:ABU, ABDALBAGE I
Entity type:Individual
Prefix:
First Name:ABDALBAGE
Middle Name:
Last Name:ABU
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1902
Mailing Address - Country:US
Mailing Address - Phone:720-276-7251
Mailing Address - Fax:
Practice Address - Street 1:1000 S DAYTON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-1902
Practice Address - Country:US
Practice Address - Phone:720-276-7251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO172A00000X172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver