Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 44847-020 | WI |
N | 111NI0900X | Internist | 44847-020 | WI |
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 036106610 | IL |
Y | 207RC0000X | Internist - Cardiovascular Disease | 036-106610 | IL |
NPI | 1366466377 |
---|---|
Provider Name | Mubashir Ahmed |
First Address | Mchenry, IL 60050-8437 |
Second Address | Huntley, IL 60142 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 19/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036106610 | STATE LICENSE (01) | IL |
34276500 | (05) | WI |
H75373 | (02) | WI |