MEDICARE: MOHAMED ZIAUDDIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	21169	TN

General Provider Information

NPI Number	:	1306891536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMED ZIAUDDIN M.D.

Provider Business Mailing Address
First Line	:	1265 E COLLEGE ST
Second Line	:
City	:	PULASKI
State	:	TN
Zip	:	38478-4541
Country	:	US
Telephone Number	:	931-363-8649
Fax Number	:	931-363-8654

Provider Business Practice Location Address
First Line	:	1265 E COLLEGE ST
Second Line	:
City	:	PULASKI
State	:	TN
Zip	:	38478-4541
Country	:	US
Telephone Number	:	931-363-8649
Fax Number	:	931-363-8654

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	10/05/2007

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