Provider Demographics
NPI:1336234756
Name:UDDIN, KHUTB MOHAMMED (MD)
Entity Type:Individual
Prefix:DR
First Name:KHUTB
Middle Name:MOHAMMED
Last Name:UDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 N DIXIE WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-3309
Mailing Address - Country:US
Mailing Address - Phone:574-243-0112
Mailing Address - Fax:574-243-3881
Practice Address - Street 1:239 N DIXIE WAY
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637-3309
Practice Address - Country:US
Practice Address - Phone:574-243-0112
Practice Address - Fax:574-243-3881
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037643A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100347010AMedicaid
INE41931Medicare UPIN