Provider Demographics
NPI:1164616157
Name:YAQUB, MOHAMMAD M (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:M
Last Name:YAQUB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:101 JOHN F KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1119
Mailing Address - Country:US
Mailing Address - Phone:561-612-8080
Mailing Address - Fax:561-612-8084
Practice Address - Street 1:101 JOHN F KENNEDY DR
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1119
Practice Address - Country:US
Practice Address - Phone:561-612-8080
Practice Address - Fax:561-612-8084
Is Sole Proprietor?:No
Enumeration Date:2007-09-01
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99808207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH115ZMedicare PIN