Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | IL |
NPI | 1124002621 |
---|---|
Provider Name | Dr. Ahmed A. Mohiuddin |
First Address | Crest Hill, IL 60435-0928 |
Second Address | Crest Hill, IL 60435-0928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31603308 | BLUE CROSS (01) | IL |
4047673 | CIGNA (01) | IL |
E18708 | (02) |