Provider Demographics
NPI:1447784012
Name:MOHAMMED AHMEDUDDIN, LLC
Entity Type:Organization
Organization Name:MOHAMMED AHMEDUDDIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMEDUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-591-0090
Mailing Address - Street 1:11661 ARCHER LN
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-3201
Mailing Address - Country:US
Mailing Address - Phone:310-591-0090
Mailing Address - Fax:
Practice Address - Street 1:11661 ARCHER LN
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-3201
Practice Address - Country:US
Practice Address - Phone:310-591-0090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001095A213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty