Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 036141775 | IL |
NPI | 1003234592 |
---|---|
Provider Name | Ahmed Moyukh Uddin |
First Address | Oak Lawn, IL 60453 |
Second Address | Oak Lawn, IL 60453 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2014 |
Last Update Date | 28/10/2020 |