Provider Demographics
NPI:1548924046
Name:MOHEYUDDIN, HUMA (MD)
Entity type:Individual
Prefix:
First Name:HUMA
Middle Name:
Last Name:MOHEYUDDIN
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 1:4720 E GREENWAY RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4355
Mailing Address - Country:US
Mailing Address - Phone:602-439-6000
Mailing Address - Fax:
Practice Address - Street 1:4720 E GREENWAY RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4355
Practice Address - Country:US
Practice Address - Phone:602-439-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-30
Last Update Date:2025-05-20
Deactivation Date:2022-05-12
Deactivation Code:
Reactivation Date:2022-07-01
Provider Licenses
StateLicense IDTaxonomies
TXBP10079530207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine