MEDICARE: MERCY MEDICAL GROUP SC INC

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

General Provider Information

NPI Number	:	1669265948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCY MEDICAL GROUP SC INC

Provider Business Mailing Address
First Line	:	2446 W DEVON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-1913
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2320 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-5242
Country	:	US
Telephone Number	:	773-565-4561
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MOHAMMED AHSAN
Credential	:
Telephone Number	:	773-565-4561

Provider Enumeration Date	:	05/28/2025
Last Update Date	:	04/21/2026

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Directions to “MERCY MEDICAL GROUP SC INC ” Practice Location

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