Basic Information
| Provider Information | |||||||||
| NPI: | 1669527594 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WASEEM | ||||||||
| FirstName: | MOHIUDDIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 241011 | ||||||||
| Address2: | |||||||||
| City: | LODI | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952419511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2093397435 | ||||||||
| FaxNumber: | 2093333054 | ||||||||
| Practice Location | |||||||||
| Address1: | 387 CIVIC DR | ||||||||
| Address2: | |||||||||
| City: | GALT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956322059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2097458080 | ||||||||
| FaxNumber: | 2097458085 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2007 | ||||||||
| LastUpdateDate: | 05/21/2015 | ||||||||
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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 | 207R00000X | C52567 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.