Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 036050567 | IL |
Y | 207KA0200X | Allergist | 036-050567 | IL |
NPI | 1194739268 |
---|---|
Provider Name | Mohammad T.k. Ghani |
First Address | Westchester, IL 60154-2664 |
Second Address | Westchester, IL 60154-2664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 16/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036050567 | (05) | IL |
D13901 | (02) | IL |