Basic Information
| Provider Information | |||||||||
| NPI: | 1578797676 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BACHOURA | ||||||||
| FirstName: | ABDO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | HQ101 UNIV OF KY 800 ROSE ST | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178003390 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17270 SE 109TH TERRACE RD | ||||||||
| Address2: | |||||||||
| City: | SUMMERFIELD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344919015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523366000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2009 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | ME141396 | FL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207XS0106X | ME141396 | FL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
No ID Information.