Provider Demographics
NPI:1710197363
Name:CHOUDHRY, MUHAMMAD I (MD)
Entity type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:I
Last Name:CHOUDHRY
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 1:891 EUREKA ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5807
Mailing Address - Country:US
Mailing Address - Phone:817-599-1200
Mailing Address - Fax:817-341-7245
Practice Address - Street 1:891 EUREKA ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5807
Practice Address - Country:US
Practice Address - Phone:817-599-1200
Practice Address - Fax:817-341-7245
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089288207R00000X, 207RE0101X
TXN0701207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMC089288OtherBCBSM
MIP00464537OtherRAILROAD MEDICARE
MI5212604Medicaid
MIMC089288OtherBCBS OF MICHIGAN
MIMC089288OtherBCBS OF MICHIGAN
TXTXB145627Medicare PIN
MIP00464537OtherRAILROAD MEDICARE
MI0M03300048Medicare PIN