Provider Demographics
NPI:1316442064
Name:SOOFI, MUHAMMAD AUSAAF-UDDIN
Entity type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:AUSAAF-UDDIN
Last Name:SOOFI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 EAST APPLE ST.
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409
Mailing Address - Country:US
Mailing Address - Phone:937-208-2004
Mailing Address - Fax:937-208-8828
Practice Address - Street 1:128 EAST APPLE ST.
Practice Address - Street 2:2ND FLOOR
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409
Practice Address - Country:US
Practice Address - Phone:937-208-2004
Practice Address - Fax:937-208-8828
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.143030207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program