Provider Demographics
NPI:1124190277
Name:ABUJABER-AMMARI, LINDA KAMIL (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:KAMIL
Last Name:ABUJABER-AMMARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716
Mailing Address - Country:US
Mailing Address - Phone:307-686-4900
Mailing Address - Fax:307-682-3466
Practice Address - Street 1:1300 W 4TH ST
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716
Practice Address - Country:US
Practice Address - Phone:307-686-4900
Practice Address - Fax:307-682-3466
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5966A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7710230Medicaid
NE83033277100Medicaid
WY112906600Medicaid
WY310654OtherBLUE CROSS BLUE SHIELD
WYW308168Medicare PIN
H55991Medicare UPIN