Healthcare Provider Details

I. General information

NPI: 1922017318
Provider Name (Legal Business Name): TASKIN U HAQUE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N MAIN ST STE A SUITE 1
BELLE GLADE FL
33430-1973
US

IV. Provider business mailing address

1100 N MAIN ST STE A SUITE 1
BELLE GLADE FL
33430-1973
US

V. Phone/Fax

Practice location:
  • Phone: 561-996-8505
  • Fax: 561-996-7331
Mailing address:
  • Phone: 561-996-8505
  • Fax: 561-996-7331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME33825
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: