Provider Demographics
NPI:1891829057
Name:ALAM, MUHAMMAD MUNIR (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:MUNIR
Last Name:ALAM
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 1:3750E HUBER ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-3901
Mailing Address - Country:US
Mailing Address - Phone:602-284-8108
Mailing Address - Fax:
Practice Address - Street 1:3750 E HUBER ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-3901
Practice Address - Country:US
Practice Address - Phone:602-214-0792
Practice Address - Fax:480-339-0288
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29511207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ584963Medicaid
G83423Medicare UPIN
AZZ115766Medicare PIN