Basic Information
| Provider Information | |||||||||
| NPI: | 1467974170 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAQUE | ||||||||
| FirstName: | MADIHA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | TRIOS CARE CENTER | ||||||||
| Address2: | 3730 PLAZA , 4TH FLOOR | ||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092216450 | ||||||||
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| Practice Location | |||||||||
| Address1: | TRIOS CARE CENTER | ||||||||
| Address2: | 3730 PLAZA , 4TH FLOOR | ||||||||
| City: | KENNEWICK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092216450 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2017 | ||||||||
| LastUpdateDate: | 08/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 125.070317 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | MD61050330 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.