Individual
FAIQA MOHYUDDIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6091 BROADWAY, MERRILLVILLE, IN 46410-2619
(219) 763-8112
(219) 764-3251
Mailing address
PO BOX 1430, PORTAGE, IN 46368-9230
(219) 763-8112
(219) 764-3251
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036121290
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01071717A
STATE LICENSE
IN
01
—
036121290
STATE LICENCE NUMBER
IL
Enumeration date
02/18/2009
Last updated
09/29/2025
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