MEDICARE: DILSHAD FAKHRUDDIN 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	207R00000X	Internal Medicine Physician	210936	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	210936	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1407997174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DILSHAD FAKHRUDDIN MD

Provider Business Mailing Address
First Line	:	420 64TH ST
Second Line	:	APT 10A
City	:	BROOKLYN
State	:	NY
Zip	:	11220-4900
Country	:	US
Telephone Number	:	646-420-8110
Fax Number	:

Provider Business Practice Location Address
First Line	:	1081 GATES AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-4303
Country	:	US
Telephone Number	:	718-443-7007
Fax Number	:	718-443-7005

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/25/2008

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