Provider Demographics
NPI:1942287826
Name:DADA, MOHAMMED ATIQ (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:ATIQ
Last Name:DADA
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:PO BOX 2660
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77404-2660
Mailing Address - Country:US
Mailing Address - Phone:979-245-2421
Mailing Address - Fax:979-245-6263
Practice Address - Street 1:200 MEDICAL CENTER CT STE 100
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-4733
Practice Address - Country:US
Practice Address - Phone:979-245-2421
Practice Address - Fax:979-245-6263
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT04221207R00000X
TXM9236207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0068REOtherBCBS (INDIVIDUAL)
TX8BJ820OtherBCBS (INV IN GROUP)
TX0068REOtherBCBS (INDIVIDUAL)
CTI27597Medicare UPIN
TX8BJ820OtherBCBS (INV IN GROUP)