Provider Demographics
NPI:1417797705
Name:BUKURU, SADDAM
Entity type:Individual
Prefix:
First Name:SADDAM
Middle Name:
Last Name:BUKURU
Suffix:
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 1:2220 DEVONPORT DR APT J702220
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-1661
Mailing Address - Country:US
Mailing Address - Phone:859-229-7078
Mailing Address - Fax:
Practice Address - Street 1:2220 DEVONPORT DR APT J702220
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-1661
Practice Address - Country:US
Practice Address - Phone:859-229-7078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-25
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company