Provider Demographics
NPI:1497884027
Name:MULK, HUMA TAZEEM (MD)
Entity Type:Individual
Prefix:DR
First Name:HUMA
Middle Name:TAZEEM
Last Name:MULK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 RICHARD RD
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1936
Mailing Address - Country:US
Mailing Address - Phone:708-982-1544
Mailing Address - Fax:219-440-7312
Practice Address - Street 1:932 RICHARD RD
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1936
Practice Address - Country:US
Practice Address - Phone:708-982-1544
Practice Address - Fax:219-440-7312
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089606207R00000X
IN01073823A208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089606Medicaid
IL036089606Medicaid
IL147267Medicare ID - Type Unspecified