Provider Demographics
NPI:1215959762
Name:UDDIN, MOHAMMAD I (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:I
Last Name:UDDIN
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:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85280-0036
Mailing Address - Country:US
Mailing Address - Phone:480-878-7425
Mailing Address - Fax:480-207-1025
Practice Address - Street 1:5690 W CHANDLER BLVD STE 2
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3356
Practice Address - Country:US
Practice Address - Phone:480-878-7425
Practice Address - Fax:480-207-1025
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40368208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ367105Medicaid
AZ367105Medicaid