1659355949 NPI number — MOHAMMAD IFTEKHAR ULLAH MD

Table of content: MOHAMMAD IFTEKHAR ULLAH MD (NPI 1659355949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659355949 NPI number — MOHAMMAD IFTEKHAR ULLAH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ULLAH
Provider First Name:
MOHAMMAD
Provider Middle Name:
IFTEKHAR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1659355949
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 N STATE ST
Provider Second Line Business Mailing Address:
GENERAL MEDICINE
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39216-4500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-984-5660
Provider Business Mailing Address Fax Number:
601-984-6870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 NORTH STATE STREET
Provider Second Line Business Practice Location Address:
DEPARTMENT OF MEDICINE DIVISION OF GENERAL INTERNAL MED
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-984-5660
Provider Business Practice Location Address Fax Number:
601-984-6870
Provider Enumeration Date:
12/01/2005

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: 207RS0012X , with the licence number:  20270 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 46137 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 131016 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1907892 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8315 . This is a "AVERA" identifier , issued by the state of ( FM ) . This identifiers is of the category "OTHER".
  • Identifier: 04-06055 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: A068 . This is a "CHAMPUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: MH9041035166 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 099K8UL . This is a "BLUE CROSS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 099K8UL , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 644957300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06022776 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: HP39736 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: P00628051 . This is a "RAILROAD" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 566034 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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