Provider Demographics
NPI:1154426476
Name:BUHARI, MUDATHIRU (MD)
Entity type:Individual
Prefix:DR
First Name:MUDATHIRU
Middle Name:
Last Name:BUHARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2236
Mailing Address - Country:US
Mailing Address - Phone:727-499-0358
Mailing Address - Fax:727-781-3312
Practice Address - Street 1:4129 W KENNEDY BLVD STE 2
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2254
Practice Address - Country:US
Practice Address - Phone:135-411-4668
Practice Address - Fax:888-249-3323
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111588207RI0200X
OH35 083003207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009667600Medicaid
FL009667600Medicaid
OH2920978Medicaid
FLFW063ZMedicare PIN