MEDICARE: MUHAMMAD QUDRAT ULLAH 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	207RC0000X	Cardiovascular Disease Physician	W3030	TX

General Provider Information

NPI Number	:	1598373144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUHAMMAD QUDRAT ULLAH MD

Provider Business Mailing Address
First Line	:	623 RUSSELL BLVD
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1247
Country	:	US
Telephone Number	:	936-260-7801
Fax Number	:

Provider Business Practice Location Address
First Line	:	623 RUSSELL BLVD
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1247
Country	:	US
Telephone Number	:	936-260-7801
Fax Number	:

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

Provider Enumeration Date	:	07/20/2020
Last Update Date	:	02/10/2026

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