Provider Demographics
NPI:1730403692
Name:MOHYUDDIN MEDICAL CENTER LTD
Entity type:Organization
Organization Name:MOHYUDDIN MEDICAL CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SADIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHYUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:618-466-3232
Mailing Address - Street 1:1309 DADRIAN PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-1686
Mailing Address - Country:US
Mailing Address - Phone:618-466-3232
Mailing Address - Fax:618-466-1950
Practice Address - Street 1:1309 DADRIAN PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:GODFREY
Practice Address - State:IL
Practice Address - Zip Code:62035-1686
Practice Address - Country:US
Practice Address - Phone:618-466-3232
Practice Address - Fax:618-466-1950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036043179Medicaid
IL036043179Medicaid
ILC44674Medicare UPIN