Healthcare Provider Details

I. General information

NPI: 1972577591
Provider Name (Legal Business Name): MOHAMMAD S ALAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 12/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N 3RD ST
TERRE HAUTE IN
47804-4045
US

IV. Provider business mailing address

2723 S 7TH ST STE A
TERRE HAUTE IN
47802-3558
US

V. Phone/Fax

Practice location:
  • Phone: 812-238-7781
  • Fax: 812-238-7793
Mailing address:
  • Phone: 812-238-1730
  • Fax: 812-242-1565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number01047585A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: