MEDICARE: MD KHADIMUL ISLAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	P125481	NY

General Provider Information

NPI Number	:	1043082951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MD KHADIMUL ISLAM

Provider Business Mailing Address
First Line	:	131 PRESTON RD FL 1
Second Line	:
City	:	CHEEKTOWAGA
State	:	NY
Zip	:	14215-3626
Country	:	US
Telephone Number	:	347-285-5909
Fax Number	:

Provider Business Practice Location Address
First Line	:	434 MONROE AVE
Second Line	:
City	:	HORNELL
State	:	NY
Zip	:	14843-2236
Country	:	US
Telephone Number	:	607-324-7740
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2023
Last Update Date	:	11/11/2025

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