Provider Demographics
NPI:1104614338
Name:UDDIN, JOTEE MAHISHA (PA)
Entity type:Individual
Prefix:
First Name:JOTEE
Middle Name:MAHISHA
Last Name:UDDIN
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36832 MELBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-3343
Mailing Address - Country:US
Mailing Address - Phone:313-502-6591
Mailing Address - Fax:
Practice Address - Street 1:36832 MELBOURNE DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-3343
Practice Address - Country:US
Practice Address - Phone:313-502-6591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program