Provider Demographics
NPI:1942348370
Name:MOHYUDDIN, SADIQ (MD)
Entity Type:Individual
Prefix:DR
First Name:SADIQ
Middle Name:
Last Name:MOHYUDDIN
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 1:1309 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:618-466-3232
Mailing Address - Fax:618-466-1950
Practice Address - Street 1:1309 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:618-466-3232
Practice Address - Fax:618-466-1950
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3643071207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036043179Medicaid
ILC44674Medicare UPIN
IL036043179Medicaid