Provider Demographics
NPI:1841217684
Name:MOHSIN, ATA UL (MD)
Entity Type:Individual
Prefix:
First Name:ATA
Middle Name:UL
Last Name:MOHSIN
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 1:340 W 23RD ST STE B
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4541
Mailing Address - Country:US
Mailing Address - Phone:850-913-9488
Mailing Address - Fax:850-522-9443
Practice Address - Street 1:340 W 23RD ST STE B
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4541
Practice Address - Country:US
Practice Address - Phone:850-913-9488
Practice Address - Fax:850-522-9443
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0087428174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2669081-00Medicaid
FLK6439Medicare ID - Type Unspecified
H84010Medicare UPIN