MEDICARE: MR. MOHAMED ZIAUDDIN MSW, LCSW

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	1041C0700X	Clinical Social Worker	1196	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134299571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MOHAMED ZIAUDDIN MSW, LCSW

Provider Business Mailing Address
First Line	:	PO BOX 528
Second Line	:	ATTN: BH PATC PROGRAM
City	:	BETHEL
State	:	AK
Zip	:	99559-0528
Country	:	US
Telephone Number	:	907-543-6730
Fax Number	:	907-543-6712

Provider Business Practice Location Address
First Line	:	324 RADIO STREET
Second Line	:	ATTN: BH PATC PROGRAM
City	:	BETHEL
State	:	AK
Zip	:	99559-0528
Country	:	US
Telephone Number	:	907-543-6730
Fax Number	:	907-543-6712

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/14/2014

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