Basic Information
| Provider Information | |||||||||
| NPI: | 1144426198 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | UDDIN | ||||||||
| FirstName: | MUHAMMAD | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4351 DFW TPKE | ||||||||
| Address2: | STE 150 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752111501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4694884300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4351 DFW TPKE | ||||||||
| Address2: | STE 150 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752111501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4694884300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2007 | ||||||||
| LastUpdateDate: | 07/23/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0000X | 25451 | OK | N | Allopathic & Osteopathic Physicians | Family Medicine | Adolescent Medicine | 208000000X | N2855 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 213476902 | 05 | TX | MEDICAID | 200119050 A | 05 | OK | MEDICAID | 213476904 | 05 | TX | MEDICAID | 213476903 | 05 | TX | MEDICAID | 47134356 | 05 | NM | MEDICAID | 213476901 | 05 | TX | MEDICAID |