Provider Demographics
NPI:1437698222
Name:HAQUE, SULTAN
Entity Type:Individual
Prefix:
First Name:SULTAN
Middle Name:
Last Name:HAQUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 8TH ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-1463
Mailing Address - Country:US
Mailing Address - Phone:732-387-6437
Mailing Address - Fax:
Practice Address - Street 1:705 8TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55024-1463
Practice Address - Country:US
Practice Address - Phone:732-387-6437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNB972067856118343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)