Healthcare Provider Details

I. General information

NPI: 1730403692
Provider Name (Legal Business Name): MOHYUDDIN MEDICAL CENTER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2010
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 DADRIAN PROFESSIONAL PARK
GODFREY IL
62035-1686
US

IV. Provider business mailing address

1309 DADRIAN PROFESSIONAL PARK
GODFREY IL
62035-1686
US

V. Phone/Fax

Practice location:
  • Phone: 618-466-3232
  • Fax: 618-466-1950
Mailing address:
  • Phone: 618-466-3232
  • Fax: 618-466-1950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SADIQ MOHYUDDIN
Title or Position: DOCTOR
Credential: M. D.
Phone: 618-466-3232