Healthcare Provider Details

I. General information

NPI: 1831119163
Provider Name (Legal Business Name): SHAIKH WAHIDUZZAMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 ALTANTA HWY
MONTGOMERY AL
36109
US

IV. Provider business mailing address

100 CAPITOL COMMERCE BLVD BLDG A SUITE 250
MONTGOMERY AL
36117-4260
US

V. Phone/Fax

Practice location:
  • Phone: 334-271-7051
  • Fax: 334-271-7055
Mailing address:
  • Phone: 334-386-1420
  • Fax: 334-386-1478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24787
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: