MEDICARE: MOHAMED DAHODWALA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	036065163	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	060053234	OTHER	IL	MEDICARE -- RR
5	060053233	OTHER	IL	MEDICARE -- RR
6	060012282	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	01618378	OTHER	IL	BCBS PROVIDER ID
4	01636774	OTHER	IL	BCBS PROVIDER ID

General Provider Information

NPI Number	:	1043230857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMED DAHODWALA MD

Provider Business Mailing Address
First Line	:	PO BOX 64568
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85082-4568
Country	:	US
Telephone Number	:	630-288-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	6441 S PULASKI RD
Second Line	:	SUITE 100
City	:	CHICAGO
State	:	IL
Zip	:	60629-5148
Country	:	US
Telephone Number	:	773-284-1234
Fax Number	:	773-284-1811

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	09/25/2025

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Directions to “ MOHAMED DAHODWALA MD” Practice Location

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