Individual
MOHAMMAD IFTEKHAR ULLAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 NORTH STATE STREET, DEPARTMENT OF MEDICINE DIVISION OF GENERAL INTERNAL MED, JACKSON, MS 39216
(601) 984-5660
(601) 984-6870
Mailing address
2500 N STATE ST, GENERAL MEDICINE, JACKSON, MS 39216-4500
(601) 984-5660
(601) 984-6870
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
46137
MN
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
20270
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04-06055
MEDICA
MN
05
—
06022776
—
MS
01
—
099K8UL
BLUE CROSS
MN
05
—
099K8UL
—
MN
05
—
131016
—
MN
01
—
1907892
ARAZ
MN
05
—
566034
—
IA
05
—
644957300
—
MN
01
—
8315
AVERA
FM
01
—
A068
CHAMPUS
MN
01
—
HP39736
HEALTH PARTNERS
MN
01
—
MH9041035166
PREFERRED ONE
MN
01
—
P00628051
RAILROAD
MS
Enumeration date
12/01/2005
Last updated
01/23/2015
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