Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 15621 | ND |
N | 207RC0200X | Critical Care Medicine | 5101019831 | MI |
NPI | 1073877999 |
---|---|
Provider Name | Mustafizur Choudhury |
First Address | Fargo, ND 58122-2484 |
Second Address | Bismarck, ND 58501-4439 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2012 |
Last Update Date | 19/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1073877999 | (05) | MI |
5823530 | BCBSM (01) | MI |