Provider Demographics
NPI:1609076777
Name:HUDA, NAZMUL (MD)
Entity type:Individual
Prefix:
First Name:NAZMUL
Middle Name:
Last Name:HUDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:
Practice Address - Street 1:303 S NAPPANEE ST
Practice Address - Street 2:STE A
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2066
Practice Address - Country:US
Practice Address - Phone:574-296-3338
Practice Address - Fax:574-296-3332
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01073182A207RC0000X, 207RI0011X
PAMD429541207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000842391OtherBCBS ELKHART CARDIOLOGY
INP01317337OtherRR MEDICARE
IN201197470Medicaid
IN201197470Medicaid