MEDICARE: GHULAM MOHEYUDDIN M.D.

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	174400000X	Specialist	A26231	CA

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	:	1447365036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GHULAM MOHEYUDDIN M.D.

Provider Business Mailing Address
First Line	:	930 SUNNYSLOPE RD STE A2
Second Line	:
City	:	HOLLISTER
State	:	CA
Zip	:	95023-5616
Country	:	US
Telephone Number	:	831-637-3766
Fax Number	:	831-637-3679

Provider Business Practice Location Address
First Line	:	930 SUNNYSLOPE RD STE A2
Second Line	:
City	:	HOLLISTER
State	:	CA
Zip	:	95023-5616
Country	:	US
Telephone Number	:	831-637-3766
Fax Number	:	831-637-3679

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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