Provider Demographics
NPI:1164580692
Name:MUMTAZ AKRAM MD INC
Entity Type:Organization
Organization Name:MUMTAZ AKRAM MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MUMTAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:AKRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-960-9455
Mailing Address - Street 1:906 S SUNSET AVE
Mailing Address - Street 2:#104
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790
Mailing Address - Country:US
Mailing Address - Phone:626-960-9455
Mailing Address - Fax:626-960-0833
Practice Address - Street 1:906 S SUNSET AVE
Practice Address - Street 2:#104
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790
Practice Address - Country:US
Practice Address - Phone:626-960-9455
Practice Address - Fax:626-960-0833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34950207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
927636Medicare UPIN
CAA34950Medicare ID - Type Unspecified