Provider Demographics
NPI:1275592198
Name:MAHMOOD, IFTIKHER UDDIN (MD)
Entity Type:Individual
Prefix:
First Name:IFTIKHER
Middle Name:UDDIN
Last Name:MAHMOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16401 NW 2ND AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-6036
Mailing Address - Country:US
Mailing Address - Phone:305-947-4734
Mailing Address - Fax:305-944-0619
Practice Address - Street 1:16401 NW 2ND AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-6036
Practice Address - Country:US
Practice Address - Phone:305-947-4734
Practice Address - Fax:305-944-0619
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME703432080A0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250880000Medicaid
FL250880000Medicaid