Provider Demographics
NPI:1851516306
Name:MOHYUDDIN, YUSUF ATA (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:YUSUF
Middle Name:ATA
Last Name:MOHYUDDIN
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1311 D ADRIAN PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-1686
Mailing Address - Country:US
Mailing Address - Phone:618-466-2523
Mailing Address - Fax:618-466-2593
Practice Address - Street 1:1311 DADRIAN PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:GODFREY
Practice Address - State:IL
Practice Address - Zip Code:62035-1686
Practice Address - Country:US
Practice Address - Phone:618-466-2523
Practice Address - Fax:618-466-2593
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036117306207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine