Provider Demographics
NPI:1508625047
Name:UDDIN, MD
Entity Type:Individual
Prefix:
First Name:MD
Middle Name:
Last Name:UDDIN
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 1:3611 CARPENTER ST STE 9
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48212-2784
Mailing Address - Country:US
Mailing Address - Phone:313-707-0191
Mailing Address - Fax:
Practice Address - Street 1:3611 CARPENTER ST STE 9
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212-2784
Practice Address - Country:US
Practice Address - Phone:313-707-0191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care