Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 036143900 | IL |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 128483 | OH |
NPI | 1053623868 |
---|---|
Provider Name | Mohammed M Ahmed |
First Address | Geneva, IL 60134-2578 |
Second Address | Geneva, IL 60134-3593 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2010 |
Last Update Date | 10/04/2019 |