Individual
MR. MAX MAHFUZUL HAQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1389 W HUNTER ST, LOGAN, OH 43138-1013
(740) 385-2197
(740) 385-9197
Mailing address
PO BOX 228, LOGAN, OH 43138-0228
(740) 380-4181
(740) 385-0865
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
35-07-0607-H
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2050999
—
OH
01
—
35070607H
STATE LICENSE
OH
Enumeration date
07/09/2005
Last updated
06/03/2019
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