Provider Demographics
NPI:1700888914
Name:MUFTI, AMJAD I (MD)
Entity type:Individual
Prefix:
First Name:AMJAD
Middle Name:I
Last Name:MUFTI
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 1:1922 LAKES EDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630
Mailing Address - Country:US
Mailing Address - Phone:812-490-7722
Mailing Address - Fax:
Practice Address - Street 1:15 ALPINE COURT
Practice Address - Street 2:
Practice Address - City:WILKES ABRRE
Practice Address - State:PA
Practice Address - Zip Code:18702
Practice Address - Country:US
Practice Address - Phone:570-823-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056108B207P00000X
IN01056108A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA820682OtherFIRST PRIORITY HEALTH
PAP00397954OtherRAILROAD MEDICARE
PA1020116790001Medicaid
INH73252Medicare UPIN
PA1020116790001Medicaid