Provider Demographics
NPI:1760652879
Name:UDDIN, IJLAL (MD)
Entity type:Individual
Prefix:
First Name:IJLAL
Middle Name:
Last Name:UDDIN
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 1:4355 BEAR GULLY RD STE 1024
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-9422
Mailing Address - Country:US
Mailing Address - Phone:407-288-8750
Mailing Address - Fax:407-647-0616
Practice Address - Street 1:4355 BEAR GULLY RD STE 1024
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-9422
Practice Address - Country:US
Practice Address - Phone:407-288-8750
Practice Address - Fax:407-647-0616
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD037977207RN0300X
FLME107810207RN0300X
IL125-050395207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine