Provider Demographics
NPI:1245299924
Name:MAHMOOD, SADEEM (MD)
Entity type:Individual
Prefix:DR
First Name:SADEEM
Middle Name:
Last Name:MAHMOOD
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 1:7200 S HAZEL ST
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-7836
Mailing Address - Country:US
Mailing Address - Phone:870-534-2900
Mailing Address - Fax:870-534-9726
Practice Address - Street 1:7200 S HAZEL ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7836
Practice Address - Country:US
Practice Address - Phone:870-534-2900
Practice Address - Fax:870-534-9726
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2652207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142512001Medicaid
AR142512001Medicaid
ARG00813Medicare UPIN