Healthcare Provider Details

I. General information

NPI: 1891748307
Provider Name (Legal Business Name): NURUL HUDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: NURUL HUDA M.D.

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N 8TH ST SUITE 216
E ST LOUIS IL
62201-2989
US

IV. Provider business mailing address

100 N 8TH ST P O BOX 367
E ST LOUIS IL
62201-2989
US

V. Phone/Fax

Practice location:
  • Phone: 618-271-5900
  • Fax: 618-271-5947
Mailing address:
  • Phone: 618-271-5900
  • Fax: 618-271-5947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: