Provider Demographics
NPI:1497497176
Name:BHUIYAN, MAHBUB MOHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHBUB
Middle Name:MOHAMMAD
Last Name:BHUIYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1990 GOLFVIEW DR APT 205
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3838
Mailing Address - Country:US
Mailing Address - Phone:248-835-6958
Mailing Address - Fax:
Practice Address - Street 1:6 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2108
Practice Address - Country:US
Practice Address - Phone:631-742-9081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP114784207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P114784OtherLIMITED PERMIT TO PRACTICE MEDICINE