Basic Information
| Provider Information | |||||||||
| NPI: | 1548201080 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHOUDHURY | ||||||||
| FirstName: | AMIMUL | ||||||||
| MiddleName: | AHSAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1052 N MONROE ST | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481623113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342429550 | ||||||||
| FaxNumber: | 7342422313 | ||||||||
| Practice Location | |||||||||
| Address1: | 1052 N MONROE ST | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481623113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342429550 | ||||||||
| FaxNumber: | 7342422313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 07/15/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 4301052445 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.