1760652879 NPI number — IJLAL UDDIN M.D.

Table of content: IJLAL UDDIN M.D. (NPI 1760652879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760652879 NPI number — IJLAL UDDIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UDDIN
Provider First Name:
IJLAL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760652879
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5745 CANTON CV STE 121
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32708-5012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-288-8750
Provider Business Mailing Address Fax Number:
407-412-7387

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5745 CANTON CV STE 121
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTER SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-288-8750
Provider Business Practice Location Address Fax Number:
407-647-0616
Provider Enumeration Date:
03/04/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  MD037977 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: ME107810 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 125-050395 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)