MEDICARE: MOHTASHAM MUHAMMED MOHIUDDIN M.D.

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	207R00000X	Internal Medicine Physician	244888	NY
2	207R00000X	Internal Medicine Physician	4301091423	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	QMX000000098898	OTHER	IL	AETNA BETTER HEALTH
2	11827677	OTHER	IL	CAQH
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518166461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHTASHAM MUHAMMED MOHIUDDIN M.D.

Provider Business Mailing Address
First Line	:	5005 WARREN ST
Second Line	:	UNIT 607
City	:	SKOKIE
State	:	IL
Zip	:	60077-2986
Country	:	US
Telephone Number	:	718-440-1726
Fax Number	:

Provider Business Practice Location Address
First Line	:	6224 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60636-2324
Country	:	US
Telephone Number	:	718-440-1826
Fax Number	:

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

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	03/07/2023

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