Provider Demographics
NPI:1518963065
Name:SIKDER, MOHAMMED AJ (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:AJ
Last Name:SIKDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 N BEVERLY AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2154
Mailing Address - Country:US
Mailing Address - Phone:520-327-6265
Mailing Address - Fax:520-327-9300
Practice Address - Street 1:2121 N BEVERLY AVE
Practice Address - Street 2:STE 105
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2154
Practice Address - Country:US
Practice Address - Phone:520-327-6265
Practice Address - Fax:520-327-9300
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20059207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0889330OtherAZ BC/BS
AZ016693-03Medicaid
1Z2902OtherHEALTH NET
AZ0889330OtherAZ BC/BS
66303Medicare ID - Type Unspecified