Basic Information
| Provider Information | |||||||||
| NPI: | 1861752685 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UL ISLAM | ||||||||
| FirstName: | MUHAMMAD | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 904 MEDICAL PARK DR | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624012193 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175402350 | ||||||||
| FaxNumber: | 2173472323 | ||||||||
| Practice Location | |||||||||
| Address1: | 1032 CROSSWINDS CT | ||||||||
| Address2: | |||||||||
| City: | WENTZVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633854836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8884031071 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2012 | ||||||||
| LastUpdateDate: | 09/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036137199 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 2018033162 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.