Healthcare Provider Details

I. General information

NPI: 1245299924
Provider Name (Legal Business Name): SADEEM MAHMOOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 S HAZEL ST
PINE BLUFF AR
71603-7836
US

IV. Provider business mailing address

7200 S HAZEL ST
PINE BLUFF AR
71603-7836
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-2900
  • Fax: 870-534-9726
Mailing address:
  • Phone: 870-534-2900
  • Fax: 870-534-9726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberE2652
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: