Provider Demographics
NPI:1477507176
Name:MOHAMMED AHMEDUDDIN DPM
Entity Type:Organization
Organization Name:MOHAMMED AHMEDUDDIN DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:RASHEED
Authorized Official - Last Name:AHMEDUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:818-637-2455
Mailing Address - Street 1:1017 N BRAND BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2906
Mailing Address - Country:US
Mailing Address - Phone:818-637-2455
Mailing Address - Fax:
Practice Address - Street 1:1017 N BRAND BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-2906
Practice Address - Country:US
Practice Address - Phone:818-637-2455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4653213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4653Medicare ID - Type Unspecified