Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 019027367 | IL |
Y | 213EG0000X | General Practice | 019027367 | IL |
N | 1223X0400X | Orthodontists | 019027367 | IL |
NPI | 1043412620 |
---|---|
Provider Name | Dr. Mohammed Adil Asim |
First Address | Northlake, IL 60164 |
Second Address | Chicago, IL 60639-1932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 16/06/2016 |