Provider Demographics
NPI:1467974170
Name:HAQUE, MADIHA (MD)
Entity type:Individual
Prefix:
First Name:MADIHA
Middle Name:
Last Name:HAQUE
Suffix:
Gender:F
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:TRIOS CARE CENTER
Mailing Address - Street 2:3730 PLAZA , 4TH FLOOR
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338
Mailing Address - Country:US
Mailing Address - Phone:509-221-6450
Mailing Address - Fax:
Practice Address - Street 1:6555 QUINCE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8202
Practice Address - Country:US
Practice Address - Phone:901-515-3150
Practice Address - Fax:901-515-3179
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61050330207R00000X
IL125.070317207RG0300X
390200000X
TN70091207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program