Healthcare Provider Details

I. General information

NPI: 1164422515
Provider Name (Legal Business Name): MAHER K AHMAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 E UNIVERSITY AVE
CHAMPAIGN IL
61820-3865
US

IV. Provider business mailing address

407 E UNIVERSITY AVE
CHAMPAIGN IL
61820-3865
US

V. Phone/Fax

Practice location:
  • Phone: 217-954-0119
  • Fax: 217-954-1698
Mailing address:
  • Phone: 217-954-0119
  • Fax: 217-954-1698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036091950
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036091950
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036091950
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: