Healthcare Provider Details

I. General information

NPI: 1770677197
Provider Name (Legal Business Name): MOHAMMAD - ZAKIULLAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W 7TH.STREET
LITTLE ROCK AR
72205
US

IV. Provider business mailing address

1501 RAHLING ROAD #302
LITTLE ROCK AR
72223
US

V. Phone/Fax

Practice location:
  • Phone: 501-257-1000
  • Fax: 501-257-5071
Mailing address:
  • Phone: 501-821-1137
  • Fax: 501-821-1137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number138060
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: