Healthcare Provider Details

I. General information

NPI: 1952453995
Provider Name (Legal Business Name): MOHAMMAD VASEEMUDDIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E LAKE ST STE 102
ADDISON IL
60101-2873
US

IV. Provider business mailing address

240 E LAKE ST STE 102
ADDISON IL
60101-2873
US

V. Phone/Fax

Practice location:
  • Phone: 630-782-9780
  • Fax: 630-782-9781
Mailing address:
  • Phone: 630-782-9780
  • Fax: 630-782-9781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036-110447
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-110447
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: