Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 4301103735 | MI |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 54033 | AZ |
NPI | 1306286158 |
---|---|
Provider Name | Mohammad Raqibul Islam |
First Address | Scottsdale, AZ 85259-5452 |
Second Address | Scottsdale, AZ 85259 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2013 |
Last Update Date | 15/03/2019 |