Healthcare Provider Details

I. General information

NPI: 1376593228
Provider Name (Legal Business Name): REDWAN UDDIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9740 CONANT ST
HAMTRAMCK MI
48212-3307
US

IV. Provider business mailing address

9740 CONANT ST
HAMTRAMCK MI
48212-3307
US

V. Phone/Fax

Practice location:
  • Phone: 313-556-9900
  • Fax: 313-556-9911
Mailing address:
  • Phone: 313-556-9900
  • Fax: 313-556-9911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301058291
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: