Provider Demographics
NPI:1417905837
Name:HAQUE, MUHAMMAD EMDADUL (MD)
Entity type:Individual
Prefix:MR
First Name:MUHAMMAD
Middle Name:EMDADUL
Last Name:HAQUE
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 1:412 PALMETTO STREET
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168
Mailing Address - Country:US
Mailing Address - Phone:386-427-4752
Mailing Address - Fax:386-426-8855
Practice Address - Street 1:412 PALMETTO STREET
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168
Practice Address - Country:US
Practice Address - Phone:386-427-4752
Practice Address - Fax:386-426-8855
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076036208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E0794Medicare ID - Type Unspecified
G71931Medicare UPIN