Provider Demographics
NPI:1285130708
Name:ABDULLAH, BUTOOL SABA (MD)
Entity type:Individual
Prefix:DR
First Name:BUTOOL
Middle Name:SABA
Last Name:ABDULLAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-2682
Mailing Address - Fax:515-643-5802
Practice Address - Street 1:16854 IVY AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-1504
Practice Address - Country:US
Practice Address - Phone:909-791-1000
Practice Address - Fax:909-781-6000
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
IAR-11368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program