MEDICARE: ATA ULHAQ MD

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	207P00000X	Emergency Medicine Physician	35047809U	OH
2	2083X0100X	Occupational Medicine Physician	35047809	OH
3	207R00000X	Internal Medicine Physician	35047809	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00194304	OTHER	OH	RAILROAD MEDICARE
8	P00374611	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000221328	OTHER	OH	UNISON
4	744087	OTHER	OH	BUCKEYE
5	000000503555	OTHER	OH	ANTHEM
6	4092373	OTHER	OH	AETNA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	364089	OTHER	OH	WELLCARE

General Provider Information

NPI Number	:	1215912068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATA ULHAQ MD

Provider Business Mailing Address
First Line	:	201 FOREST PARK CIR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4916
Country	:	US
Telephone Number	:	850-248-7777
Fax Number	:	850-248-7779

Provider Business Practice Location Address
First Line	:	201 FOREST PARK CIR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4916
Country	:	US
Telephone Number	:	850-248-7777
Fax Number	:	850-248-7779

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	11/09/2022

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Directions to “ ATA ULHAQ MD” Practice Location

Language	Start Address	Practice Location

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