Provider Demographics
NPI:1861521940
Name:MUBARAK, ABDULLAHI ISA (MD)
Entity type:Individual
Prefix:
First Name:ABDULLAHI
Middle Name:ISA
Last Name:MUBARAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:HUNTER
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1550 YANKEE PARK PL
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1868
Mailing Address - Country:US
Mailing Address - Phone:937-439-4949
Mailing Address - Fax:937-439-4948
Practice Address - Street 1:1550 YANKEE PARK PL
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-1868
Practice Address - Country:US
Practice Address - Phone:937-439-4949
Practice Address - Fax:937-439-4948
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051593207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0685585Medicaid
OH0685585Medicaid
OHA17552Medicare UPIN