Provider Demographics
NPI:1750316139
Name:ALAM, MOHAMMED FEROZ (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:FEROZ
Last Name:ALAM
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 1:299 W FOOTHILL BLVD
Mailing Address - Street 2:STE 212
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3804
Mailing Address - Country:US
Mailing Address - Phone:909-949-8866
Mailing Address - Fax:909-385-0379
Practice Address - Street 1:536 E FOOTHILL BLVD
Practice Address - Street 2:STE B
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3955
Practice Address - Country:US
Practice Address - Phone:909-981-5882
Practice Address - Fax:909-946-0833
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33746207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A337460Medicaid
D12948Medicare UPIN
CAA337460Medicare ID - Type Unspecified