Provider Demographics
NPI:1760652879
Name:UDDIN, IJLAL (MD)
Entity Type:Individual
Prefix:
First Name:IJLAL
Middle Name:
Last Name:UDDIN
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 1:5745 CANTON CV STE 121
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5012
Mailing Address - Country:US
Mailing Address - Phone:407-288-8750
Mailing Address - Fax:407-412-7387
Practice Address - Street 1:5745 CANTON CV STE 121
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708
Practice Address - Country:US
Practice Address - Phone:407-288-8750
Practice Address - Fax:407-647-0616
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD037977207RN0300X
FLME107810207RN0300X
IL125-050395207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine