Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | IL |
NPI | 1285712851 |
---|---|
Provider Name | Dr. Mohammad Ikramuddin |
First Address | Park Ridge, IL 60068-1110 |
Second Address | Park Ridge, IL 60068-1110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |