Healthcare Provider Details

I. General information

NPI: 1780246728
Provider Name (Legal Business Name): IMMAD ATTIQUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2019
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WELLNESS WAY C/O APOGEE PHYSICIANS
MILFORD DE
19963-4364
US

IV. Provider business mailing address

100 WELLNESS WAY C/O APOGEE PHYSICIANS
MILFORD DE
19963-4364
US

V. Phone/Fax

Practice location:
  • Phone: 302-430-5175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC1-0024538
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: