Healthcare Provider Details

I. General information

NPI: 1366531568
Provider Name (Legal Business Name): MUHAMMAD MUHAMMAD ISLAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 BERNARDIN AVE SUITE 200
COLUMBIA SC
29204-2039
US

IV. Provider business mailing address

PO BOX 50183
COLUMBIA SC
29250-0183
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-1137
  • Fax: 803-256-1138
Mailing address:
  • Phone: 803-256-1137
  • Fax: 803-256-1138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number17200
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: