Provider Demographics
NPI:1215912068
Name:ULHAQ, ATA (MD)
Entity type:Individual
Prefix:
First Name:ATA
Middle Name:
Last Name:ULHAQ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 FOREST PARK CIR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4916
Mailing Address - Country:US
Mailing Address - Phone:850-248-7777
Mailing Address - Fax:850-248-7779
Practice Address - Street 1:201 FOREST PARK CIR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4916
Practice Address - Country:US
Practice Address - Phone:850-248-7777
Practice Address - Fax:850-248-7779
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047809U207P00000X
OH350478092083X0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00194304OtherRAILROAD MEDICARE
OH0610191Medicaid
OH000000221328OtherUNISON
OH744087OtherBUCKEYE
OH000000503555OtherANTHEM
OH4092373OtherAETNA
PA0011849960019Medicaid
OHP00374611OtherRAILROAD MEDICARE
OH364089OtherWELLCARE
PA552537SV8Medicare PIN
OHP00374611OtherRAILROAD MEDICARE
OHP00194304OtherRAILROAD MEDICARE
OH0610191Medicaid
OHUL4178972Medicare PIN