Provider Demographics
NPI:1962405142
Name:UDDIN, MOHAMMAD KALEEM (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:KALEEM
Last Name:UDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:NONE
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:36243 INLAND VALLEY DR
Mailing Address - Street 2:STE 210
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-9549
Mailing Address - Country:US
Mailing Address - Phone:951-677-2300
Mailing Address - Fax:951-677-1033
Practice Address - Street 1:36243 INLAND VALLEY DR
Practice Address - Street 2:STE 210
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-9549
Practice Address - Country:US
Practice Address - Phone:951-677-2300
Practice Address - Fax:951-677-1033
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83767207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H34621Medicare UPIN