Provider Demographics
NPI:1891748307
Name:HUDA, NURUL (MD)
Entity Type:Individual
Prefix:
First Name:NURUL
Middle Name:
Last Name:HUDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NURUL
Other - Middle Name:
Other - Last Name:HUDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:100 N 8TH ST
Mailing Address - Street 2:P O BOX 367
Mailing Address - City:E ST LOUIS
Mailing Address - State:IL
Mailing Address - Zip Code:62201-2989
Mailing Address - Country:US
Mailing Address - Phone:618-271-5900
Mailing Address - Fax:618-271-5947
Practice Address - Street 1:100 N 8TH ST
Practice Address - Street 2:SUITE 216
Practice Address - City:E ST LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62201-2989
Practice Address - Country:US
Practice Address - Phone:618-271-5900
Practice Address - Fax:618-271-5947
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL596520Medicare ID - Type UnspecifiedMEDICARE ID
ILD10725Medicare UPIN