Provider Demographics
NPI:1386741676
Name:ABDULKARIM, AHMAD BASHAR (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:BASHAR
Last Name:ABDULKARIM
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:901-227-3255
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:1030 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2127
Practice Address - Country:US
Practice Address - Phone:901-521-8990
Practice Address - Fax:901-577-7367
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36429208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO34183015OtherBCBS KANSAS CITY
KS200264370AMedicaid
KS481950OtherFIRSTGUARD
MO205930316Medicaid
P00152854Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MO34183015OtherBCBS KANSAS CITY
MO205930316Medicaid