Provider Demographics
NPI:1972577591
Name:ALAM, MOHAMMAD S (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:S
Last Name:ALAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2723 S 7TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-3558
Mailing Address - Country:US
Mailing Address - Phone:812-238-1730
Mailing Address - Fax:812-242-1565
Practice Address - Street 1:1600 N 3RD ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-4045
Practice Address - Country:US
Practice Address - Phone:812-238-7781
Practice Address - Fax:812-238-7793
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047585A207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00224453OtherRAILROAD MEDICARE
IN200193520Medicaid
IN147180PPMedicare PIN
IN200193520Medicaid