Basic Information
| Provider Information | |||||||||
| NPI: | 1871817817 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IKRAMULLAH | ||||||||
| FirstName: | MIR | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8500 | ||||||||
| Address2: | |||||||||
| City: | PINEHURST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283748707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107151000 | ||||||||
| FaxNumber: | 9107151926 | ||||||||
| Practice Location | |||||||||
| Address1: | 155 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | PINEHURST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283748710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107151000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2010 | ||||||||
| LastUpdateDate: | 03/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 51875 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 2016-00052 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 01083413A | IN | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 51875 | KY | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 2016-00052 | NC | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.