Provider Demographics
NPI:1902834930
Name:AMIN, MUHAMMAD MUDASSAR (MD)
Entity Type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:MUDASSAR
Last Name:AMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HAFIZ
Other - Middle Name:MUHAMMED MUDASSAR
Other - Last Name:AMIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 E EVERGREEN
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:MO
Mailing Address - Zip Code:64429-0557
Mailing Address - Country:US
Mailing Address - Phone:816-632-2101
Mailing Address - Fax:816-649-3383
Practice Address - Street 1:409 WEST AUBERRY GROVE
Practice Address - Street 2:
Practice Address - City:JAMESPORT
Practice Address - State:MO
Practice Address - Zip Code:64648
Practice Address - Country:US
Practice Address - Phone:660-684-6252
Practice Address - Fax:660-684-6254
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008029327207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO785000002OtherMEDICARE PART B