Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 27466 | NE |
Y | 207RI0011X | Interventional Cardiology | 01074113A | IN |
N | 207RI0011X | Interventional Cardiology | 27466 | NE |
NPI | 1124048913 |
---|---|
Provider Name | Mohammad Z Hoque |
First Address | Muncie, IN 47303-4988 |
Second Address | Lafayette, IN 47904-2119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 14/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000876778 | ANTHEM PROVIDER NUMBER (01) | IN |
201227500 | (05) | IN |
5905041 | (05) | NC |
I63239 | (02) |