MEDICARE: DILSHAD FAKHRUDDIN MEDICAL PC

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	210936-1	NY

General Provider Information

NPI Number	:	1629210158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DILSHAD FAKHRUDDIN MEDICAL PC

Provider Business Mailing Address
First Line	:	420 64TH ST APT 10A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-4975
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	:	646-420-8110
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DILSHAD FAKHRUDDIN
Credential	:	MD
Telephone Number	:	646-420-8110

Provider Enumeration Date	:	03/30/2009
Last Update Date	:	03/30/2009

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