Most Relevant Information
Provider Data
| NPI Number: | 1003268095 |
| Provider Name: | MOHAMMAD ISLAM |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/01/2016 |
| Last Updated: | 12/09/2022 |
Provider Practice Location
1272 W MAIN ST STE 503
NEWARK
OH
430552058
Practice Location Phone/Fax
| Phone: | 2205641805 |
| Fax: | 2205641806 |
Provider Mailing Location
1320 W MAIN ST
NEWARK
OH
430551822
Provider Mailing Phone/Fax
| Phone: | 2205644027 |
| Fax: |