Healthcare Provider Details

I. General information

NPI: 1265735807
Provider Name (Legal Business Name): MUHAMMAD UBAIDULHAQ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 S EMERSON AVE STE 110
INDIANAPOLIS IN
46237-3303
US

IV. Provider business mailing address

5955 S EMERSON AVE STE 110
INDIANAPOLIS IN
46237-3303
US

V. Phone/Fax

Practice location:
  • Phone: 317-318-8276
  • Fax: 317-279-6429
Mailing address:
  • Phone: 317-318-8276
  • Fax: 317-318-8276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number482-320
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number482-320
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number01081623A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: