Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 036091955 | IL |
Y | 207RP1001X | Pulmonary Disease | 036091955 | IL |
NPI | 1063405223 |
---|---|
Provider Name | Mujahid Mohammad Hussain |
First Address | Sycamore, IL 60178-3192 |
Second Address | Sycamore, IL 60178-3192 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 10/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036091955 | (05) | IL |
G98037 | (02) | IL |