Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 036098559 | IL |
NPI | 1043363211 |
---|---|
Provider Name | Rana Hamid Mahmood |
First Address | Decatur, IL 62526-6328 |
Second Address | Decatur, IL 62526-6328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 25/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036098559 | (05) | IL |
G83573 | (02) | |
G83573 | (02) | IL |